In this dream I'm sitting in a strange man's black convertible. I don't recognise who he is at all, but apparently in the dream we are on some sort of date.
So we are driving around up and down a few highways, just enjoying the feel of the wind in our hair. Then we decide to go to this shopping centre, which looks a lot like Casuarina. We take a left at the KFC, much like the real Casuarina, except as soon as we turn I see a huge boom gate which is not there in real life.
He is still speeding along so I tell him he'd better stop at the boom gate. He says "why should I stop? I don't have any money". I am somewhat horrified and tell him that I'll pay for the parking.
"All right then." He says grudgingly and pulls up at the boom gate, where there's a little hut with a man sitting inside.
"Wait here," he says to me and ducks into the hut.
The next thing I know I look up and the man is no longer there.
"What happened to the man?" I ask him.
"Don't worry about it, let's go." He says.
As we drive into the parking lot I am overwhelmed by this feeling that he somehow killed the ticket collecting man, so I start asking him again and again, somewhat hysterically "What did you do to him? What happened to him?"
Finally he sighs and says "well, if you must know.."
He pulls out a tab of pills from his pocket and shows it to me - it has the Mon-Tue-Wed etc pattern written on it like the oral contraceptive pill. He turns it around and most of the pills are missing.
He says, "I made him take all these pills, and he died of an oestrogen overdose."
Then I wake up.
Tuesday, 7 June 2011
Random Darwin, part two
Darwin's one of those places where one sees strange stuff all the time, and despite the fact my phone takes really crappy photos, I often have the urge to pull it out and snap a random photo. My interns will testify that I frequently announce "Kodak moment!" on the ward round, for example when we were trying to find a ward in the private hospital (the public frequently overflows into various corners of the private), and the nurses helpfully directed us to this sign on the wall:
One day I finally went up to this ward in the hospital called "Constant Care", which is actually really a nursing home because all the patients in it are waiting for nursing homes, and found this sign at the entrance next to the fish tank (yes, all this nursing home has to entertain its residents is a fish tank)
Back to the good old private hospital, they got a bit tired of the public staff using their things all the time, and even their bench space they were very protective of. So on one ward, which was half public and half private, I found this sign, reminiscent of primary school days...
Of all the random things I've taken photos of from medication charts, I thought this was probably the most hilarious. Fleet enema TDS, only in Darwin...
And I couldn't resist taking a photo of my intern Olivia who was so tired on our massively long ward round that she sat down on the nearest piece of furniture (of course we don't have chairs).. the patient's wheelie walker.
And here on a random antique scale....
On a different ward, a patient complained that she couldn't get hold of the nurses because there were no call bells.. so she was given one of those old fashioned ringing bells (here is Olivia again demonstrating its use). And of course our patient was an adult, just the hospital was so full they stuck her in the children's ward.
Away from the hospital, one day I went for a walk and found a dead snake just outside the driveway of the hospital... what can one say but Normal For Darwin?
A handful of really random things have happened since I moved to Darwin, and this has to come close to the top of the list. One night I was meant to go with a bunch of medical students to Lee Point for a bonfire, but I ended up staying at home because I wanted to sell my microwave. Eventually I sold the microwave and made my way to Jacky's house for dinner. While bonfiring one of the boys, a 21yo French 1st year medical student, had burnt his foot trying to firewalk. So he sat in the bathtub sulking while running his foot under cold water, and Jacky went to look for his "special bag of medications" which he'd stashed in a cupboard somewhere.
It was actually two whole plastic bags full of medications, and it was the weirdest thing ever sorting through them! Aside from the obvious paracetamol, nurofen, antibiotics (half a dozen types, including ones I'd never heard of), anti-histamines and steroid creams, there was also clonazepam syrup (just in case one develops epilepsy, perhaps?), anti-fungals, a combination paracetamol-tramadol tablet (very bizarre), oxazepam (maybe to be taken if life in Oz got too stressful?) and an anti-depressant! All the medications laid out covered a whole side table, and I was simply amazed by what one's father would give an otherwise healthy 21yo to take to a developed country where medications are readily available!
Anyway.. I gave him some panadol and nurofen, and couldn't resist giving him half an oxazepam! Then we all crowded into the tiny bathroom to keep him company, eating kangaroo stir fry to the sound of running water.. Now if that's not random, I don't know what is.
One day I finally went up to this ward in the hospital called "Constant Care", which is actually really a nursing home because all the patients in it are waiting for nursing homes, and found this sign at the entrance next to the fish tank (yes, all this nursing home has to entertain its residents is a fish tank)
Back to the good old private hospital, they got a bit tired of the public staff using their things all the time, and even their bench space they were very protective of. So on one ward, which was half public and half private, I found this sign, reminiscent of primary school days...
Of all the random things I've taken photos of from medication charts, I thought this was probably the most hilarious. Fleet enema TDS, only in Darwin...
And I couldn't resist taking a photo of my intern Olivia who was so tired on our massively long ward round that she sat down on the nearest piece of furniture (of course we don't have chairs).. the patient's wheelie walker.
And here on a random antique scale....
On a different ward, a patient complained that she couldn't get hold of the nurses because there were no call bells.. so she was given one of those old fashioned ringing bells (here is Olivia again demonstrating its use). And of course our patient was an adult, just the hospital was so full they stuck her in the children's ward.
Away from the hospital, one day I went for a walk and found a dead snake just outside the driveway of the hospital... what can one say but Normal For Darwin?
A handful of really random things have happened since I moved to Darwin, and this has to come close to the top of the list. One night I was meant to go with a bunch of medical students to Lee Point for a bonfire, but I ended up staying at home because I wanted to sell my microwave. Eventually I sold the microwave and made my way to Jacky's house for dinner. While bonfiring one of the boys, a 21yo French 1st year medical student, had burnt his foot trying to firewalk. So he sat in the bathtub sulking while running his foot under cold water, and Jacky went to look for his "special bag of medications" which he'd stashed in a cupboard somewhere.
It was actually two whole plastic bags full of medications, and it was the weirdest thing ever sorting through them! Aside from the obvious paracetamol, nurofen, antibiotics (half a dozen types, including ones I'd never heard of), anti-histamines and steroid creams, there was also clonazepam syrup (just in case one develops epilepsy, perhaps?), anti-fungals, a combination paracetamol-tramadol tablet (very bizarre), oxazepam (maybe to be taken if life in Oz got too stressful?) and an anti-depressant! All the medications laid out covered a whole side table, and I was simply amazed by what one's father would give an otherwise healthy 21yo to take to a developed country where medications are readily available!
Thursday, 26 May 2011
Dream: the sun doesn't set at Dripstone anymore
In this dream, a whole bunch of us from the hospital are at Dripstone cliffs, sort of like the medical registrar welcoming party they threw us in January. We are standing around chatting and sipping drinks when I looked up and realised the sun was gone.
"Are we here to watch the sunset?" I ask the nearest person.
"Oh, no, the sun doesn't set at Dripstone anymore." They reply (I can't remember who they are at all!)
"Why not?" I ask, puzzled how the sun can choose where it sets.
"Well, the hospital ran out of money and stopped paying the subscription fee, so the sun has gone somewhere else now."
Disappointed, I look down at the sea to see if anything else has changed at the cliffs. Then someone says "We can get the sun back if only we win this competition."
"What competition?" murmurs the crowd.
"Actually it's more like a randomised controlled trial. We take these two types of laundry powder and if we can guess which is the more high powered one, we can get the sun back."
Someone else walks among the crowd with a large cane basket, distributing two identical packets of white powder to everyone. I'm just looking at my packets when someone shoves a trophy in my face and says "Congratulations! You've won the most enthusiastic participant award!"
I splutter, "What??" and look at the trophy. On it my name is all garbled, and I can't quite make out what it says. I put the packets of powder in the trophy. Then I wake up.
"Are we here to watch the sunset?" I ask the nearest person.
"Oh, no, the sun doesn't set at Dripstone anymore." They reply (I can't remember who they are at all!)
"Why not?" I ask, puzzled how the sun can choose where it sets.
"Well, the hospital ran out of money and stopped paying the subscription fee, so the sun has gone somewhere else now."
Disappointed, I look down at the sea to see if anything else has changed at the cliffs. Then someone says "We can get the sun back if only we win this competition."
"What competition?" murmurs the crowd.
"Actually it's more like a randomised controlled trial. We take these two types of laundry powder and if we can guess which is the more high powered one, we can get the sun back."
Someone else walks among the crowd with a large cane basket, distributing two identical packets of white powder to everyone. I'm just looking at my packets when someone shoves a trophy in my face and says "Congratulations! You've won the most enthusiastic participant award!"
I splutter, "What??" and look at the trophy. On it my name is all garbled, and I can't quite make out what it says. I put the packets of powder in the trophy. Then I wake up.
Tuesday, 24 May 2011
Dream: the radioactive barramundi
In this dream I'm just about to embark on a long road trip with my dad, I think we were planning to drive from Darwin to Sydney but I can't remember the route we were going to take. I look out the window and our Honda is parked just outside, but it looks like the alleyway outside our house in Shanghai. I wonder how it's possible that our car seems to have made its way to Shanghai for a roadtrip starting in Darwin. Looking around, I seem to be sitting in my living room in Shanghai too.
I tell my dad that we are already running late, so we need to look at the map and check how far we can get that day. He tells me not to worry, then there is a knock at the door.
When I open the door a man comes in pushing in a catering-style trolley, covered in a cloth. This is the type of trolley that's used to serve food at meetings etc, with enough space for big platters to be stored on several tiers. He says he has a present for us and without delay starts telling us about how he caught a giant barramundi and wants to give it to us to take on the road trip.
Just as I'm wondering why there are giant barramundi in Shanghai, he lifts the cloth from the trolley and I see a whole row of giant jars like the ones used to preserve rice wine. He starts taking the jars down and naming the fillets "this one came from the front of the left side of the barra... this one's from near the tail" - fillets of barramundi seem to be swimming in some amber-coloured unidentified liquid inside the jars.
He finishes unloading the jars, probably about 20 of them in total. There are 3 jars left on the trolley and I ask the man "what's in those?" He picks up one and shows it to me, and it is the most hideous fish head I have ever seen.
"Hold on, you can keep those. I don't like fish heads." I say to the man.
He looks disappointed and points to the other two jars, "What will I do with these then?" he asks.
I look at the other two jars and each seems to contain a giant hideous fish head.
"Wait, if you only caught one barramundi, how come you have three heads?" I ask.
He stares at me like I've just asked a crazy question and finally says "Don't you know? This fish was raised in radioactive nuclear-contaminated water in Japan, it's full of genetic mutations!"
Then I wake up.
I tell my dad that we are already running late, so we need to look at the map and check how far we can get that day. He tells me not to worry, then there is a knock at the door.
When I open the door a man comes in pushing in a catering-style trolley, covered in a cloth. This is the type of trolley that's used to serve food at meetings etc, with enough space for big platters to be stored on several tiers. He says he has a present for us and without delay starts telling us about how he caught a giant barramundi and wants to give it to us to take on the road trip.
Just as I'm wondering why there are giant barramundi in Shanghai, he lifts the cloth from the trolley and I see a whole row of giant jars like the ones used to preserve rice wine. He starts taking the jars down and naming the fillets "this one came from the front of the left side of the barra... this one's from near the tail" - fillets of barramundi seem to be swimming in some amber-coloured unidentified liquid inside the jars.
He finishes unloading the jars, probably about 20 of them in total. There are 3 jars left on the trolley and I ask the man "what's in those?" He picks up one and shows it to me, and it is the most hideous fish head I have ever seen.
"Hold on, you can keep those. I don't like fish heads." I say to the man.
He looks disappointed and points to the other two jars, "What will I do with these then?" he asks.
I look at the other two jars and each seems to contain a giant hideous fish head.
"Wait, if you only caught one barramundi, how come you have three heads?" I ask.
He stares at me like I've just asked a crazy question and finally says "Don't you know? This fish was raised in radioactive nuclear-contaminated water in Japan, it's full of genetic mutations!"
Then I wake up.
Tuesday, 10 May 2011
A day in Singapore
On my way back from China, I decided to stop in Singapore for a day of food.
Yes yes, the Singapore river was very picturesque in the morning light, but where was all the food? Every store and stall seemed to be shut, and hardly anyone was on the street except a few confused looking tourists and some street cleaners. I walked in some random direction till I finally came across a shop full of people even at 8am on a Saturday morning.
I've never had bak kut teh before, but this was pretty good. Pork rib soup simmered till the stock is full of flavour, and the spices have really shown their true flavour. There is no greasiness at all, instead a pleasantly refreshing after taste. The pork falls off the bone, and makes for a delicious accompaniment to rice and pickles.
Feeling rather content, I walked down the road and somehow ended up in Chinatown. Walking down the side streets, I found myself first at the muslim mosque, where workers were painting the walls furiously. Then I came across the Sri Mariamman temple, where some serious procession was in progress. Around the corner I went into the Buddha's Tooth relic temple and even there, there was a crowd chanting prayers and lighting incense.
Out of luck with temples, I ended up in the Chinatown food court. Not really feeling hungry, I couldn't resist the sight of a super long queue heading to the glutinous rice stall. Here a man with funny chorea like movements was dishing up the glutinous rice along with a sprinkling of peanuts and salty fried shallot crisps. It was quite savoury, and would have been nicer if there was an element of sweetness to it.
Feeling truly too full, I headed to the Singapore Art Museum for a spot of air conditioning.
It just happens that the Biennale is on, and I happened to arrive at the SAM at the time of a guided tour with a very interesting and spirited lady. This was a fantastic exhibition (I didn't even make it to the other three sites) of modern art, with the theme being "My Home". The idea was to invite a group of artists from around the world to use the spaces within the exhibition centres to explore the concept of home. My absolute favourite exhibit was an artist who followed six Singaporean families on their usual shopping, and then set up a room with six fridges full of their purchases, inviting the viewer to think about what sort of lives they lead...
Coming out of the SAM, I set off in another random direction and ended up in Albert Centre near Bugis, where I actually stayed last time. I stopped for some more snacks.
Too much shopping in Bugis later, I headed back to the airport. At Tanah Merah interchange, I saw an amazing sunset over the top of a handful of apartment buildings.
Meanwhile, I munched on a curry puff from Old Chang Kee...
Feeling rather bored in the airport, I finished off my day of eating with a bowl of fish ball noodle soup. The fish balls weren't as good as the place that serves fish ball laksa in Terminal 3, a little bit too chewy for my liking. The soup was rather bland too, but it was pretty all right for an airport meal!
It did feel like half of Singapore was out on the day I was there, probably because it was a Saturday and plus it was election day too. There's food just about everywhere in Singapore... I'd love to live there for a bit and try everything out. And of course there's great shopping too, I couldn't resist this sign in a MRT station.
Yes yes, the Singapore river was very picturesque in the morning light, but where was all the food? Every store and stall seemed to be shut, and hardly anyone was on the street except a few confused looking tourists and some street cleaners. I walked in some random direction till I finally came across a shop full of people even at 8am on a Saturday morning.
Out of luck with temples, I ended up in the Chinatown food court. Not really feeling hungry, I couldn't resist the sight of a super long queue heading to the glutinous rice stall. Here a man with funny chorea like movements was dishing up the glutinous rice along with a sprinkling of peanuts and salty fried shallot crisps. It was quite savoury, and would have been nicer if there was an element of sweetness to it.
Feeling truly too full, I headed to the Singapore Art Museum for a spot of air conditioning.
It just happens that the Biennale is on, and I happened to arrive at the SAM at the time of a guided tour with a very interesting and spirited lady. This was a fantastic exhibition (I didn't even make it to the other three sites) of modern art, with the theme being "My Home". The idea was to invite a group of artists from around the world to use the spaces within the exhibition centres to explore the concept of home. My absolute favourite exhibit was an artist who followed six Singaporean families on their usual shopping, and then set up a room with six fridges full of their purchases, inviting the viewer to think about what sort of lives they lead...
Coming out of the SAM, I set off in another random direction and ended up in Albert Centre near Bugis, where I actually stayed last time. I stopped for some more snacks.
Soy milk pudding with almonds.
Nasi lemak (coconut rice) with fried chicken.
Too much shopping in Bugis later, I headed back to the airport. At Tanah Merah interchange, I saw an amazing sunset over the top of a handful of apartment buildings.
Meanwhile, I munched on a curry puff from Old Chang Kee...
Feeling rather bored in the airport, I finished off my day of eating with a bowl of fish ball noodle soup. The fish balls weren't as good as the place that serves fish ball laksa in Terminal 3, a little bit too chewy for my liking. The soup was rather bland too, but it was pretty all right for an airport meal!
It did feel like half of Singapore was out on the day I was there, probably because it was a Saturday and plus it was election day too. There's food just about everywhere in Singapore... I'd love to live there for a bit and try everything out. And of course there's great shopping too, I couldn't resist this sign in a MRT station.
Tuesday, 26 April 2011
The story of Mr C
Given that he had severe anaemia, we asked the surgeons to investigate his gastrointestinal tract with scopes. They agreed but thought that regardless of the diagnosis, he wouldn’t survive a big operation to fix it. Then the anaesthetists refused to put him to sleep for the procedure, arguing that it would make no difference to the outcome.
That day, I talked to him and his daughter about what was happening. I explained that he was probably losing blood from a cancer but we aren’t going searching for it because he may not survive the operation to fix it anyway. We will transfuse him with blood whenever he needed it, but he might die soon regardless. They were understanding and accepting, and he was keen to go home, so I let him go.
A few weeks later, he came back vomiting blood. He’d vomited endlessly at home and some of it had gone into his lungs. He was really unwell this time, and the surgeons and anaesthetists put aside their previous weariness and looked in his stomach, where they found a big tumour completely obstructing the stomach outlet. The cancer came as no surprise to the whole family, and we started him on palliative radiation therapy. He also got a stent across the obstruction so he could still eat something, but we all knew that this was palliation.
Even with the diagnosis clear, Mr C stayed in hospital for ages, getting the stent placed and the feeding regimen adjusted, being treated with antibiotics for his pneumonia, and having so many other miscellaneous things sorted. Somehow he remained cheerful through all of it, and everyday when I went in to see him I would be struck by how bright and hopeful his eyes were, despite all the pain and suffering he was going through. One of his daughters had brought in a photo of him on his favourite daybed at home with his dog, who he loved dearly.
One day I went into his room and for the first time in several weeks of being in hospital, he didn’t smile at me when I greeted him. Instead he looked down at his bedcovers, at his distended stomach, and told me “I’m sick of this, I just want to die.” It wasn’t a particular thing that had happened, but it had all just caught up with him – the pain, the nausea, the weakness, the inability to get out of bed. At that moment I resolved to get this man home, even if he were just to spend one day in his own home with his family and his beloved dog.
So we had a family conference around the bed with all the staff involved in his care, and after that we put in place the final arrangements to let him go home. The community palliative care team were going to visit him, he would have oxygen and feeds as he had in hospital, his family would learn to manage his medications through the feeding tube... everything seemed to be going well, and we were so happy for him when he finally left hospital, though I knew then that I probably would never see him again.
Another few weeks later, I saw his obituary in the newspaper. I heard from other doctors that once back at home, his condition got much worse and he constantly asked the palliative care doctors to give him something to go to sleep forever. But of course that is illegal (though it was once upon a time legal in the Northern Territory), and we are left with symptom management.
It is easy enough to say if someone has physical pain, or nausea, or constipation, or secretions, or any medical complaint, we have medications and treatments that may help alleviate those symptoms. But what about emotional suffering? If someone has reached the end of their life and no longer wishes to live, but has no ability to take their own life, then what can we prescribe for that? If it is unethical or unmoral to prolong one’s physical suffering, then is it not cruel to prolong one’s emotional suffering?
These are difficult questions, and thus euthanasia has been debated fiercely all over the world. The arguments against euthanasia inevitably revolve around the sanctity of life (with many religious variations) and the potential for abuse of the system if euthanasia were allowed. Others argue that in the terminal stages of illness one loses the ability to assess with a clear mind one’s overall situation, and thus is not competent to make the decision.
I feel that all these arguments have their weaknesses. Life is indeed precious, but quality of life is of paramount importance, and cannot be judged by anyone other than the individual themselves. Doctors and others can make some guess at what one’s quality of life is, but ultimately everyone has to live their own life. As for the potential for abuse of the system, is there not such a possibility with everything in life? This should not be used as an excuse to run away from the issue. I agree that euthanasia should be tightly controlled so that the potential for disaster is minimised, but I do believe there is a role for euthanasia for some selected patients.
All that aside, to Mr C – I know you have gone to a better place, I hope you rest in peace.
Sunday, 24 April 2011
Dream: the consultants nursing home
In this dream I'm standing inside a nursing home, which looks just like the Corella ward (a ward in Darwin Private Hospital which the public hospital has taken over while renovating ward 4B). I'm standing in the little alcove at the end of the corridor near Bed 18, next to the couches that are usually there.
Suddenly I can distinctly hear the voice of a consultant coming from one of the rooms. I peek inside the nearest room and it's actually the activities room, full of toothless oldies (somehow none of them had their dentures!) giggling and poking at each other. A diversional therapist is trying to get them to dance, but they are all sitting down in wheelchairs which aren't locked so when they try to move they slide around on their wheels.
I realise with a start that all the oldies are consultants from the hospital, and in the dream I'm very afraid. I go to the kitchen where the usual stainless steel fridge has been replaced with a big white fridge. I see a bag of vegetables and think "I'll just put them in the fridge so the oldies can have lunch later".
I open the fridge which makes rather loud whirring noises, and attempt to put the vegetables in the crisper section at the bottom of the fridge. It's odd as the left drawer is about 1/4 the size of the right drawer, such that there is a tiny little one on the left and a huge one on the right. They are dark green in colour and there's a lot of water at the bottom of them, so I try to scoop out the water as I'm putting the vegetables in.
Just as I'm putting a bunch of bok choy in, my ex med student Maggy comes in with a plate of salmon patties and says "have one! they are really delicious!"
Then I wake up.
Suddenly I can distinctly hear the voice of a consultant coming from one of the rooms. I peek inside the nearest room and it's actually the activities room, full of toothless oldies (somehow none of them had their dentures!) giggling and poking at each other. A diversional therapist is trying to get them to dance, but they are all sitting down in wheelchairs which aren't locked so when they try to move they slide around on their wheels.
I realise with a start that all the oldies are consultants from the hospital, and in the dream I'm very afraid. I go to the kitchen where the usual stainless steel fridge has been replaced with a big white fridge. I see a bag of vegetables and think "I'll just put them in the fridge so the oldies can have lunch later".
I open the fridge which makes rather loud whirring noises, and attempt to put the vegetables in the crisper section at the bottom of the fridge. It's odd as the left drawer is about 1/4 the size of the right drawer, such that there is a tiny little one on the left and a huge one on the right. They are dark green in colour and there's a lot of water at the bottom of them, so I try to scoop out the water as I'm putting the vegetables in.
Just as I'm putting a bunch of bok choy in, my ex med student Maggy comes in with a plate of salmon patties and says "have one! they are really delicious!"
Then I wake up.
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