Daytrip to Noumea

One morning during the ward round, my boss showed me an email written in strange English about a patient in Noumea with severe ARDS. Asked what my thoughts were, I answered I think she needs ECMO! and was told that that was indeed the plan. I asked if I could tag along, not really expecting that it would really happen – after all I am supposed to be at work looking after patients! But the next thing I knew, the head honcho of cardiac anaesthesia had organised a seat for me on the retrieval plane.

So on this sunny afternoon, we stood outside RPA waiting for a taxi with our dark green ECMO bags (2 large duffles and 2 square bags, one of which contained the precious Maquet Cardiohelp machine). The whole setup was surprisingly compact and light, and as the surgeon would later remark, we can put someone on ECMO in the supermarket!

We went the backway through the taxi driver hangouts of Alexandria to the private part of Sydney airport, adjacent to the domestic terminal. Our terminal was a fancy building with hippy paintings, plush leather couches, fancy coffee machine and plentiful glossy magazines. Aesop handwash in the bathroom – what planet am I on? I thought. As we waited for everyone to arrive, domestic jets landed on the tarmac right in front of our noses. 

We boarded our Learjet 55, which was a vast improvement on the smaller Learjet 36 that we used to fly around NT in. The aircraft was relatively spacious and well set up with the removal of 2 seats to accommodate the stretcher. The cardiac anaesthetist, surgeon and I occupied the back pod of 4 seats along with our giant oxygen bottle. The temperature was regulated (no more teeth chattering at altitude) and the stability of the aircraft during takeoff and landing was excellent. There was even a little pulldown service area where one could have a hot drink and some snacks from the mini oven! It was pretty damn luxurious compared to my previous experiences with small planes in Darwin.

The others slept but I was too excited to sleep, and ended up chatting with the co-pilot and the Careflight nurse most of the way. We watched the sun set, gliding through the thick cloud layer, scattering orange rays everywhere. 

As the light faded, we descended through myriad layers of cloud moving in different directions, finally landing in Noumea to light sprinkling rain. 

The police met us on the tarmac and we filled out forms by the dim light of the ambulance that had come to fetch us. It was the first time I was stamped both in and out of the country at the same time! They obviously weren’t worried about us overstaying.

The ambulance was positively ancient, the back piled with equipment that did not fill us with confidence. The cervical collars looked like they’d been reused hundreds of times, dirty packets of gauze and grubby looking bottles of fluids lined the shelves. From where we sat on a ricketty bench we could hardly see outside as we drove the 40 minutes from the airport to Gaston Bourret hospital.

I saw a Bingo! Parlour sign as we pulled into the hospital street and wondered if that was a popular form of entertainment in New Caledonia. Then we were there, stumbling out onto the footpath at the front entrance. We loaded our bags onto a discarded hospital bed which didn’t have any functioning steering, brakes or sides. A petite woman managed to help us wheel this into ICU Service de Reanimation which I thought was such an apt name for ICU.

The ICU was brightly lit, sparkling clean and full of modern equipment – it would put many Australian hospitals to shame. The nurses and doctors were dressed in white scrubs and this did indeed make them stand out as the health care professionals – I really liked it!

We visited the patient along with the French intensivist on duty. We looked at the ventilator, infusions, blood tests and X-rays just as we would do at home, then a few phone calls were made and we decided to hold off putting the patient on ECMO for the time being. The pilots have specific rules about how long they can work before they need to have a mandatory rest, so by our calculations we could have two hours to observe the patient and make sure our decision was correct. 

What else to do but dinner? The French intensivist generously offered his car, which we promptly drove onto the wrong side of the road. Just as well there was hardly anyone out on a weeknight at 8pm, and everything seemed to be shut including the supermarket! We went to a waterfront restaurant, ate some super fresh fish, drank Perrier, and chatted about how this would be the most expensive dinner any of us would ever have (imagine, a private flight to New Caledonia just for dinner!)

Back at the hospital, we confirmed the patient was not deteriorating and packed our bags to leave. I was surprised that the intensivist was still on duty, and he told me they usually have no registrars! They have one at the moment, so one of the ten lucky intensivists get to be on-call with a registrar but she doesn’t do on-call by herself. Seems like a pretty tough life, but I guess it’s only 5 nights a month and the patients are getting the best standard of care. Just walking past the rooms, it seemed like the disease acuity in the 10-bed Service de Reanimation was pretty high – almost everyone was ventilated, and about half on dialysis. It’s apparently so busy that their 12-bed HDU mostly serves as a second ICU. 

On the way back to the airport, I sat in the front of the ambulance with the solid Melanesian ambo who looked like he could defeat anyone by sitting on them. The freeway was straight and featureless, I felt deplete of adrenaline and quite drowsy. I slept for some of the three hour flight back, waking up occasionally to see a perfect semi-lunar moon shining brightly above our heads like a street lamp. The field of stars was  simply incredible as we were flying above the cloud layer. We were so close to them that it was like we could reach out and touch them, yet they stretched so far beyond our fields of vision that they were infinite.

It was freezing in Sydney when we landed, and the customs officers looked as exhausted as we were. We lugged the gear back to the perfusion office, and I crawled into bed at 3am finally. And that was that, the end of our Noumean adventure. I had thought excitedly on the way to Noumea – in the years to come I will always remember this, my first retrieval mission. Even though we didn’t bring back the patient, I think I still will remember this day as when my love for retrieval was re-ignited. Now I’m certain I have to do some real retrievals!

Food: April & May

An impromptu lunch from a healthy eating stall at Eveleigh markets - roast vegetable tart, broccoli & feta quiche, and a yummy gluten-free banana bread. You know you are in Sydney when everything is delicious, tiny and pricey!

 

Salad Banh Mi from Marrickville Pork Roll. Not as good as a "real" pork roll, but pretty damn good. Especially love that pickled daikon, coriander and chilli.

An excellent breakfast at Element 6 in West Ryde. Baked eggs with chickpea and haloumi, topped by coriander relish and sprinkled with zaatar. The pillowy pita bread was just perfect to scoop up this spicy concoction, and I absolutely adored the double coriander flavour of roast coriander seeds used in the stew and the vibrant coriander relish on top.

Vegetarian eggs benedict from Thyme Square in Hornsby. This was pretty tasty - roast eggplant, zuccini and sweet potato atop good toast, a couple of well poached eggs and a solid hollandaise. Shame service was terrible though.

 Behold the new equivalent of the original cheeseburger that S and I used to eat all the time at Cafe Giulia. This is an amazing toasted bagel with avocado, tomato and haloumi. Really hits the spot along with one of their awesome juices.

Isn't this pretty as a picture? This is called "the most amazing vegan salad" at In the Annex which was pretty damn amazing. Chickpeas sit atop a bed of garlic hummus, topped by slivers of baby carrots and radish. The whole thing is bound together by a very mild chilli dressing and sprinkles of zaatar. Home made bread made the perfect scoop for this. If all food was this amazing, end.

Fleetwood Macchiato in Erskineville is one busy place, we waited over an hour for a table! These perfectly poached eggs were served with a softly-softly pickled eggplant, slivers of celery & fennel and topped with roasted almonds. Sounds like a strange combination, but the combined flavours were heavenly. The bread by the Bread & Butter project was also incredible, I could just eat that alone.

Now, it's hard for me to have a food post without some ramen. It's hard to eat ramen as a vegetarian - this beautiful one is from Gumshara but after picking out all the pork and dunking half a bowl of chilli pickled veg in it, I did feel like I was eating pickle ramen. 

Enter the solution. Rising Sun workshop in Newtown is a ramen popup bar which repairs motorcycles, and serves ramen too. They have three simple options - the Dark (pork), the Light (chicken? fish? can't remember) and the Monk (vegetarian). The vegetarian broth is amazing, and the first time I tried it I had to ask if it really was vegetarian. Apparently they have been throwing kilos of shiitake mushrooms in there, along with whole roasted bulbs of garlic and onion. The condiments are quite traditional - seaweed, bamboo, shallots. Each bowl is served with a slab of miso-roasted eggplant and half an egg (I was there with 2 non-egg eaters so I got all their eggs!).

 

This place is utterly amazing for vegetarians. 

A lake in Addis, and a plane crash

A beautiful lake in Addis 
(I looked on Google maps, and there is no such lake..)

In this dream, Papaya is working for a NGO in Ethiopia and has moved to Addis. She's renting a house with 3 other NGO workers who all seem young and funky, of the hippie idealistic type. We are all sitting around in the living room chatting and smoking, the dark space filled with the earthy smell of smoke. Her housemates suggest that we go to a lake near Addis, which they rave wonders about. They are amazed that neither of us have visited, and say that it is the most amazing sight in all of Ethiopia.

The next day we set out to bike to the lake. Perhaps true to the fact that I can't ride a bike in real life, I get stuck about halfway to the lake and my legs won't move anymore. We are on the side of a relatively empty highway, so we ditch my bike and I hitch a ride on the back of Papaya's bike.

When we arrive at the lake it is an utterly majestic sight. The water is a royal blue, so clear that one can see the bottom and all the little fish swimming in the lake. It stretches as far as the eye can see, resembling an inland sea. There is hardly any vegetation around the lake, and the water is so still the surface shimmers like a diamond. We dip our toes in and the water is cold - I realise that the weather is quite cold at this moment in time. We sit down on the rocks by the lakeshore and have a picnic. I am struck by how there are no other people at the lake, locals or tourists.

When we decide to go back to Addis, Papaya suggests that we take the "back way" which she says will be faster. First we ride through desert-like landscape, dry and arid, dotted with little shrubs. Then we get to a farming area where we plough through the narrow paths that farmers have made in between fields. Finally we encounter a really muddy stretch where the dust road has been flooded time and again. In this part, trucks suddenly appear out of nowhere and splatter us with mud as we ride past.

We get back to Addis and it's 4:30pm. Dirty and weary, we drag ourselves into Papaya's house and collapse on the couch. Neither of us can get up except to fetch some Diet Coke. As we sip it (so refreshing after a long tiring ride!), Papaya suddenly says, you know this is why there is so much cancer in the world.

What do you mean? I ask, puzzled by her random comment.
Diet coke is the reason for all the cancer in the world. She says, looking rather solemn. I'm so glad you've come to help me spread the message all around Ethiopia, we will start tomorrow.

Awww.. I think in my head. I thought I was here for a holiday!

Then I woke up.


A plane crash
In this dream I am living in an apartment on the 9th floor with my dad and grandma. Outside there are many other apartment buildings, and the landscape is unidentifiable. We are sitting in the living room which faces out of a very large glass window.

I am looking through the window when I suddenly notice that there is a plane approaching the area very rapidly. It is flying so low down that I can read Air France on its side. Lurching wildly, it appears to be dropping altitude quickly then cruising for a few seconds, then dropping again. I am gripped by a nauseous sense of fear in the pit of my stomach, and I stand up to get a closer look.

As I approach the window I see the plane come closer and closer to our building. Then it disappears from view and I realise it has just skimmed the top of our building. I turn around to see if I can see it from a different window, then I hear a huge explosion which is loud beyond description.

The world turns white. All noise disappears momentarily.

Then there is a high pitched buzzing sound in my ears, which I instinctively know is a leftover effect from the massive noise of the crash. The air seems to be vibrating and it's almost as if I can touch the soundwaves. I am crouched on the ground along with my family, and I have a little laugh at myself as if to say - how does crouching on the ground help if a plane crashes into our building?

The buzz subsides slowly and I help my grandma to her feet. Nothing is damaged in our apartment and we all sit down in our chairs again. I notice that there's an obs machine in the living room and I decide to do my own observations. When I put the Sats probe on, my heart rate reads 150 and there's no oxygen saturation. I put the blood pressure cuff on and I can't get it to read the first 3 times, even though it inflates so much my arm starts to go numb.

I must be really stressed from this. I think to myself. But that's funny, I don't feel stressed.

The BP finally reads 190/  and the diastolic remains empty. I stand up and look out the window again. There is a huge crater where the building opposite ours was, and I strain to see if there are any parts of the plane I can see.

Then I wake up

Shanghai: images from the French Concession

The French Concession holds a special place in my heart. It is such an atmospheric part of Shanghai, a hidden oasis amongst all the crazy new developments. The few streets near my house are the best preserved in the whole area, with their French maple trees lining the streets like silent soldiers.

Through my childhood, I saw these magnificent trees change through every season. In spring and summer, the bright green leaves make a thick foliage that stands strong despite the smog and pollution. The change of weather in autumn sees a change in the leaves to all shades of deep auburn and gold, scattering as the wind rustles gently. They crunch softly underfoot, a sound heard only among these streets. The trees stand tall but bare in winter, waiting patiently for the warmth to bring new growth again.

Each time I visit Shanghai, I am grateful that these trees around my place have remained in spite of all the new building developments in this busy modern city.

The French Concession is now quite a trendy popular area, especially as an expat neighbourhood. Boutique shops are everywhere, scattered amongst the old residential buildings. It is nice to see the defiance against name brand-consumerism that is rampant in modern China.

Old French houses converted into restaurants and shops along Fuxing W Rd. 

 

Fuxing W Rd #133, my favourite house in Shanghai (I just adore those oddly shaped windows). Previously a Moroccan restaurant, now a Belgian restaurant. 

 Only in the expat neighbourhood! Gelateria on Wuyuan Rd.

Discrete tattoo parlour on Fuxing W Rd. 

 Random homeware shop on Anfu Rd.

A visit to Shanghai is not complete without a visit to La Casbah (or three). I first discovered this hole-in-the-wall cafe opposite the Shanghai library while on elective at the hospital next door. Nothing, and I really mean nothing (from the menu board to the prices to the worn cushions.. to this sugar pot) has changed in the last 9 years and it is so refreshing to see something constant in this ever-changing city. How nostalgic I am!

Three May dreams

Pepitas

In this dream, K came to give me a lift to the train station. The time is maybe 6pm and it is dark as I get into his car. I notice that I am wearing a lovely wrap dress that I've not seen before, white in colour with a delicate light blue floral pattern. I also have a dark blue wrap and a small clutch. I sit in the car and chat with him randomly about things I cannot remember.

As we drive out onto the main road, the street lights become brighter and I notice that there is a large stain down the front of my dress. It looks like a red wine stain and it's so huge that I can't believe I didn't notice it before. I try covering it up with the wrap but there's no way to cover it and I am slightly horrified. I ask K if we can go back to my place so I can change but he says no it's too late now. We are descending down a steep hill and at the bottom we stop outside a large glass building. It is a bookshop named Austral's and he says "This is where I live now, I can't go any further."

We both get out of the car. He goes into the bookshop and goes up the stairs to his place. I turn and walk to the train station, feeling self conscious about my dress. There is a real crowd at the entrance to the station and I wonder what the fuss is about as I get closer. Where the ticket turnstiles are, there are lots and lots of dispensers like in those co-op shops, full of nuts and dried fruit. Pepitas! I think to myself, I need some pepitas to put on salad.

Then I wake up.


Ranger selling teddies

In this dream I am driving to C's house. Along the way I am stopped at a traffic light and I look around me. It looks like my neighbourhood in Shanghai and I feel puzzled because I'm in my Sydney car. I can hear the "beep... beep..." of the pedestrian crossing signal, which also doesn't exist in China. I feel even more confused when I see J standing on the side of the road waiting to cross the road.

Hey, I'll give you a lift! I wind down the window and shout to her. She's dressed in a long winter coat and a red scarf. She doesn't hear me, crosses the road and walks off.

The next scene is in a national park where we are walking along a well marked semi-paved trail which doesn't really look like a bush track. J is complaining that she needs to go to the bathroom, but we are in the middle of the bush. Though the track is in excellent condition, we are surrounded by dense jungle and the light feels low.

All of a sudden we emerge into brightness and we have come to a carpark. There is a large toilet block and we all go towards it. Inside there are multiple cubicles but each one is utterly disgusting in its own way. I cannot bring myself to go into any of them. Then I get to the very last one which is in the corner, and inside there is just a single bed immaculately made with fresh white linen. There is a hole in the ground and the bed is half perched over the hole. I squat on the ground hoping that I miss the bed as I try to pee into the hole. I reach to get some toilet paper and when I tear it off, I realise it's the corner of someone's black stocking.

As I walk out, I realise the door to the cubicle is one giant bookshelf, which is packed with those flat teddies doubling as hot water bottles. It all makes sense to me now - the park ranger lives in this cubicle and makes a side living from selling flat teddies!

Then I wake up.


A freestyle marriage

In this dream I am married to one of the Bankstown anaesthetists. I know this instinctively at the beginning of the dream even though he has not appeared yet. I am at a conference by myself and I'm staying in a really swanky hotel. After the conference finishes for the day, I go back to my room and decide to have a shower.

When I turn on the taps for the shower, the water starts spurting out of it in all different directions. The water pressure is strong and hot water is blasting uncontrollably everywhere. With some trouble, I manage to turn it off. I go outside and ask the manager, who tells me to have a bath. So I plug in the bath and turn the taps on. It's one of those antique clawfoot baths and it looks beautiful and inviting.

With one foot I step into the bath and the water temperature is perfect. As I stick my other foot in, the bottom of the bath suddenly gives way and I fall into the water. The bottom of the tub has gone and it has turned into a swimming pool. My room is also not there anymore, as the swimming pool appears to be outside. It is dark and there is a little moonshine, illuminating the surface of the water a pale yellow. The water is quite warm, and I wonder momentarily whether I am swimming in a geothermal pool. Then I realise with a start that I am doing perfect breast stroke, which I can't do in real life. I swim along leisurely, enjoying the glittering moonlight, gentle ripples and immense warmth of this huge swimming pool.

Suddenly there is someone next to me, also swimming breast stroke at a similar tempo. I turn and realise that it is a woman I met at the conference. We start talking about how strange it is that the hotel has turned into a swimming pool. And then the scene abruptly ends.

I am in bed with this aforementioned anaesthetist and I say to him, I have something to tell you. I would like to bring a woman into our relationship.

He looks at me with an imperceptible smile and says, that's fine.
Phew, I think, that was bloody too easy to be true.

I also have something to tell you, he says. I have been seeing a man as well, and I would like to bring him into our relationship.

I am startled and wake up.

Food: March

The highlight of March was the camping trip and those oh-not-poisonous mushrooms we picked in Oberon, which I later saw advertised as exotic saffron milkcaps (does sound damn exotic) at a market for $20/kg! I've been getting back into making dal again and eating simple meals like dal, brown rice and curd (and lime pickle).

I have written about the vegetarian bento at Nazimi before, it is truly awesome. Here's a better photo of my bento - who thought of wrapping a nigiri in cucumber and topping with edamame, so cute! the fried potato sushi was surprisingly good too, as were the croquettes which had the right crunchy exterior with dreamy smooth inside. Definitely a winner even though dessert's now not included..

 Breakfast at Brewtown. The Berkelouw was such an institution in Newtown, I'm sure lots of locals were sad when it closed down. In its space is this hippy new cafe, sporting a faux-industrial feel with dim lighting and exposed bricks. A coffee bar runs along the length of the room, and a row of filters look like chemistry class! I had the most delicious breakfast of crispy polenta, two perfectly poached eggs with a gooey centre, herby field mushroom, asparagus and parmesan. It was like a dance on the tongue, the flavours bold yet so complementary. I would happily eat this every weekend.

Another breakfast at Brickfields. This is a middle-of-nowhere cafe in Chippendale, a little removed from all the hustle & bustle of Surry Hills. I was starving so started on coffee and this polenta, lemon and black sesame loaf. I ordered it because the lady in front of me ordered it, and I was too tired to think after nights, and it looked yummy. And it was just the perfect thing to go with coffee, all dense and crumbly with a good zing and little sesame explosions.

Then I had a salad of roasted organic tomatoes, snake bean and lentil salad. I was sceptical about this at first, since it seemed like the dish had too many influences to "work". Tomato - Western, snake bean - Asian, lentil - Indian, parsley - Mediterranean.. but it worked wonderfully well. The amazing crusty white sourdough was the perfect partner to this salad. I was surprised by how delicious it was! Definitely want to return to try other things at this little bakery.

 

Another breakfast at Foodies deli in Sandringham. This place was abuzz with families and dogs - a nice neighbourhood feel. The vegetarian big pan had a bit of everything - Brasserie sourdough, fried eggs, tomatoes, mushies, spinach, spuds and the star, haloumi.

Finally, I love Dough bakery in Town Hall - everything there is delicious, and I love wandering around having little samples of everything. The worst part is trying to decide what to get. This little bread lobster was so adorable!

Camping (2): looking for mushrooms in Oberon

 Leaving Kanangra, we headed to Oberon for some mushroom picking. The nearby Vulcan state forest has several roads leading into the forest, where one can forage for mushrooms. We were so sad to see that blackberries were being sprayed in the area - they looked so plump and delicious!

 

Heading into the forest was like being in Hansel and Gretel. There was something magical about the slightly damp smell of the pine trees, the undergrowth crunching crisply, and the sunlight streaming through the trees. All the trees looked the same, and if not for the view of the road it could have been very disorienting. For the first few minutes, we saw no mushrooms at all. I started wondering if mushroom picking wasn't what I envisaged it to be.. like it was more like mushroom hunting.

Then we saw a saffron milkcap, surrounded by more.. and then in whichever direction we looked, we saw them everywhere! Many were hidden by the undergrowth, but the telltale bumps in the ground became more obvious to us as we picked more. Saffron milkcaps are easily identifiable by their distinct saffron colour, large round cap with an indentation on top, and clearly ridged gills on the underside.

At first we picked whatever we saw, but soon we realised there must have been thousands of mushrooms in the forest! We started picking only the "beautiful" ones, whatever that may be. We contemplated whether larger ones or smaller ones would be more tasty (well... we never found out), so took a selection of sizes.

We found only saffron milkcaps in the first part of the forest we went to, so we drove to a different part to see what we would find. What an interesting experience that was! As we wandered into the forest, I said wouldn't it be nice to see some poisonous mushrooms too?

And they were everywhere! I was fascinated by the magnificent poisonous mushrooms, which were the most vivid shades of orange and red. The toadstools looked impossibly like the ones on super mario.

In the second forest we picked lots of slippery jacks, which have a brown satiny cover (peeled before consumption) and a bright yellow smooth underside. Whoever sees these types of mushrooms in supermarkets?

The lady at the information centre told us that of the many varieties of mushrooms in the forest, these are the most easily identifiable non-toxic varieties and hence they are recommended. The field mushrooms which resemble mushrooms in supermarkets (white cap, white stem) can be confused with the toxic varieties, and so the rule is (somewhat surprisingly) don't pick anything that looks like a normal mushroom! Maybe this one was a poisonous slippery-jack lookalike? 

Where's the mushroom?

The roads around Oberon were completely different to the mountain landscape - all pastoral scenes with lush green fields and grazing livestock. It was a beautiful day too.

We had decided to camp in Oberon, but the campground in Black Springs near the mushroom picking forest was basically a park in the middle of town, all windy and exposed. We decided to go to the millionth acre campground near Hampton State Forest, but unfortunately that area has been heavily logged and the campground now sits amidst sad looking tree stumps much like a wasteland. We didn't find either of them palatable so headed back to Perrys Lookdown to camp for our last night.

Alas at dinner time we took out our mushrooms and found that the saffron milkcaps were bruised and looking very sad with a greenish fungal sheen. If we had known we should have taken more care with storing them! We ended up feeding most of the saffron milkcaps to the bush, but the slippery jacks were sturdier.

The next morning we packed up and headed to Anonymous cafe in Blackheath for breakfast. This was a pretty chic cafe that wouldn't look out of place in Surry Hills. Our breakfast burrito was very In-the-Annex-esque, and their date & walnut sodabread was pretty damn tasty.

We went for a walk from Govett's Leap to Evan's lookout. It was a beautifully clear day and the view from Govett's Leap was expansive and just spectacular.

We passed by Bridal Veil falls, and when the sun was just in the right direction, a hint of a rainbow could be seen.

Why walk on the path when you can climb a massive fallen tree?

It was lovely to get out into the wilderness again and enjoy the fresh air before another bout of sitting in a little room reading about medicine...

Panorama from Govett's leap