Thursday, 1 December 2022

A snippet from November's writing

Not infrequently, we get palliative care consults to talk to patients about “dying”.  


Some of these are very obvious requests. The patient has progressive cancer, the cancer is spreading throughout the body and “taking over” their life. The patient has failure of a vital organ and it deteriorates to the point of not being able to sustain organ function. In these cases, it is clear what the palliative care team’s involvement is. As the active treatments taper off, the palliative care side of things become dominant. We focus more on the patients’ comfort, their symptoms and on doing what we can to achieve a comfortable dignified death. 


But some of our palliative care consults are not so obvious. It is hard to peel back what is behind the requests sometimes. What does it mean when someone who is not “obviously” dying requests palliative care consultation to talk about dying? How do we understand what it really means when patients say that they have “had enough”?  


I once saw a lady who had been in hospital for five months after having a double lung transplant. Her story I will tell another day. She was well and truly fed up with the hospital. She hadn’t slept well for months, she was sick of being woken up every night by the nurses who wanted to check her blood pressure. She was sick of all the blood tests, her arms never having the opportunity to recover when they were being poked and prodded all the time. She was sick of all the doctors not talking to each other and asking her the same questions all the time. 


She had been thinking about dying for well over a month when she insisted to the lung transplant team that she wanted to talk to palliative care. They told her that she was doing “too well” for palliative care, and that she didn’t really need palliative care. After all, wasn’t she “recovering” from her transplant? She insisted and eventually they relented. 


When I met her, we talked about the options going forward. We talked about Medical Assistance In Dying (MAID), and what it involves. Once she understood what it would really look like, she said she didn’t want MAID. We talked about best supportive care, of stopping her active treatments and allowing her life to take its natural course. Once she understood what it would look like to stop her anti rejection meds and to reject her transplanted lungs in a “natural” state, she said she didn’t want to go ahead with best supportive care either. Well, what was left?  She was sick of the hospital, but she didn’t want to die either. We talked about rehab and going home, and eventually that was where we left it. We talked together to her daughter who said she was going to buy a sofa bed and move into her apartment to help once she was discharged. 


It sounds like a “funny” story that one could be asking for palliative care so as to consider the options for dying, and then end up with the conclusion of going to rehab. But this is very real for many patients. After all, how do we know what dying involves if we don’t explore what dying means? 


This brings me to the next question, what does it mean to ask for MAID? 


In the old days, there was no Medical Assistance In Dying. Essentially, it was illegal to give any medications to hasten someone’s death. One could lose one’s medical licence, or worse, end up in jail, for helping someone to hasten their own death. In the countries where it did not exist, it became a clandestine operation that some patients took into their own hands by contacting Euthanasia communities in other countries where it was legal. Patients with cancer flew across the world to access MAID-equivalents in countries where they could access it. 


Then MAID was legalised in Canada and the whole landscape of dying changed. Patients with a foreseeable death were permitted to apply for MAID once they met certain criteria. But it was an arduous process. They had to sign a form, undergo two separate independent assessments by “MAID clinicians”, doctors who were trained to assess intent and suitability for MAID. The patients had to be of sound mind, not confused, able to make their own decisions and not be coerced by others. They had to prove that their illness was life-limiting, which was often hard to determine since doctors usually erred on the conservative side if the exact prognosis was not clear. The cloudy line of “foreseeable death” was drawn on the question of whether they were likely going to die in the next six months. They had to discuss their suffering, whether it be physical or psychological. Finally after all these conditions were met, they had a long ten day cooling off period before it could finally take place. 


Only certain patients were able to access MAID due to all these logistical hurdles. Many of them were discouraged by the complexities and difficulties. Some became confused and couldn’t sign the forms correctly. Others had to sacrifice their pain medications just in case they were too drowsy to ensure that MAID went ahead. The ten day cooling off period also posed problems for people - some died in pain, uncomfortable and not in the way that they wanted. There were many frustrations in the process. 


Until now, things have changed. The government passed a new bill in March 2022 that allows a far more liberal interpretation of the MAID rules. Under the current rules, people are able to access MAID if they have a serious health condition, even if it may not imminently lead to death. 


Mr T was in the ICU when the ICU team sent a palliative care consult request. “Patient asking for MAID” was all it said. It was confusing since palliative care is a different service to the MAID team. 


The computer system showed that he was admitted with chest pain due to esophagitis. Unable to glean any more information from the chart, I headed to the ICU to talk with Mr T. He was lying in the ICU bed in a hospital gown, attached to the monitor and a bag of IV fluids. 


“Tell me about what brought you here.” I asked Mr T. 


“Mmmm…” He said. 


After a long pause I wondered what was going on. I didn’t recognise the heritage of his name but I wondered if perhaps he couldn’t understand English well. 


“Would you like an interpreter?” I asked. 


“Mmmm… No need.” He said with a very soft sing-song voice. 


“What happened to bring you to the hospital?” I asked him again. 


“Mmmm… I had chest pain.” He pointed to the centre of his chest. “Here, very bad.” 


“I couldn’t swallow.” He said, “Mmmm… swallowing was painful. Very painful.” 


“Did something happen to bring that on?” I asked. 


“Mmmm… I take too much.” He said. “Too much oil.” 


“Oil?” I wondered if I had heard wrong, struggling to remember if it was written in the chart that he was taking some kind of oil.


“CBD oil.” He looked down at his hands, “My friends told me it’s good for relaxing.”


“I see, and how much CBD oil?” I asked. Then I realised I had no idea what the normal dose of CBD oil was. 


“Mmm…. a lot.” He said, “I wanted to relax. Relax a lot.” 


He had taken so much CBD oil that it had burned the wall of his oesophagus and given him oesophagitis. 


Then he told me about how he had developed a severe unrelenting headache earlier in the year, and after seeing several different doctors finally got a scan of the head. The scan showed a benign tumour in the pituitary gland, pressing on the nerves behind the eyes. The pressure from the tumour caused him to have blurry vision. It affected his life badly, especially as he was unable to prepare food because of the vision. 


He went to see a neurosurgeon who told him he needed an operation to remove the pituitary tumour. He was afraid of what might happen, especially since he had no one to look after him. After he saw several more specialists, he opted to have radiation therapy instead to shrink the tumour. 


“Mmmm… I want to die.” He said, “Can you help me?” 


“Can you tell me more about what is behind that wish?” I asked him. 


“Mmmm… I just want to die.” He said, “Can you help me?”


“I would like to find out a bit more about your social situation.” I asked him, “Can you tell me about your family?” 


“Mmmm…” A long pause followed. “Not necessary.” 


“Who is close to you?” 


“Mmmm…” He looked away. “Nobody.” 


“What do you do for work?” I asked. 


“Mmmm…” He fiddled with the sheets. “ODSP.” ODSP stands for the Ontario Disability Support Program. 


“I see.” I said, “In case something happens to you, who would we call? Who is your next of kin?” I tried a different track. 


“Mmmm… Nobody.” He replied, “Mmmm… I just want to die. Can you help me die?” 


“Can you tell me more about why you want to die?” 


“Mmmm… I am alone. I have nobody.” He said, 


“I just want to die.” He repeated, “Life is hard. Too hard.” 


I felt puzzled by his request. His brain tumour was benign. It wasn’t cancerous and it was not going to spread throughout the body. The location was bad, for sure, affecting his vision, but it wasn’t something that would imminently take his life. 


“Mmmm… Did you bring the forms?” He asked suddenly. 


“Forms?”


“Forms, for dying.” He said firmly.


“I’m very sorry, I’m from the palliative care service.” I said, “I’m not from the team that organises dying. That’s the MAID team, that stands for Medical Assistance In Dying.” 


“Mmmm… I don’t care.” He said, nodding vigorously. “I just need the forms. Can you bring the forms?” 


“Mr T, I understand that you want the forms, but I’m not sure that you would be eligible for MAID.” I said, “I’m not sure that your illness qualifies for MAID, since it is a benign tumour you have in the brain.” 


“But…” He trailed off, “Other people on ODSP have died by MAID. Mmmm… it’s possible. Definitely possible.” 


“My friend, he died by MAID.” He said. 


“I understand, your friend may have been in a different situation.” I said gently, “In your situation, I’m not sure you can get MAID, but I can certainly ask the MAID team to come and see you.” 


“Mmmm… Life is too hard.” He said, “I have no one, I don’t know anybody, no-one cares if I am dead or not.” 


“Mmmm… I don’t have enough money on ODSP.” He continued, “I’m always hungry. I don’t want to live like this. Mmmm… isn’t that enough?” 


I felt heartbroken for this man. He seemed like a nice man. What had happened to him along the way to derail his life? Where were the people that loved him? 


I apologised to him for not being able to help him with MAID. He seemed angry at me and pulled the blanket over his head. I asked him if there was anything else I could do to help him and he reached one hand out from under the blanket to wave me away. 


I spoke to the ICU team and asked them to get psychiatry to see him. Perhaps he was depressed? I thought. I also asked social work to see him, perhaps it was a precarious housing situation that made him want to die? 


A few days later, he had recovered from the oesophagitis that was caused by the CBD oil and was discharged home. I never saw him again, but by chance noticed later that he had presented to the emergency department ten days after I saw him, complaining of dizziness because he had very little to eat. 


What is the role of MAID in patients like this? As doctors, we are so accustomed to breaking down problems into “manageable chunks” so that we can “fix them”. But how do we fix a whole life? What do we do about patients who are lonely, socially isolated and estranged from families? Perhaps they are sad about the way that their lives have worked out. Perhaps they are struggling to live on the meagre government pensions. Perhaps they have unsafe or insecure living circumstances. At what point can we say that the patient is “suffering enough” to be allowed to die by MAID? It really begs us to consider this question as a society. Should the marginalised, homeless or socially disadvantaged population be allowed to pursue active death due to the condition of their life? Are we prematurely taking away the chance for people to “recover” from these episodes in life? And who are we to judge that their quality of life is so poor that they can be medically assisted to die? 


I have no answers, only questions.


Wednesday, 2 November 2022

In My Kitchen: November 2022

I cannot believe I just typed November! October was an incredibly beautiful month of fall in Toronto, the vivid and vibrant changing leaves are my favourite thing about living in Canada! 

In my kitchen this month... 

Let's begin with this most simple of meals, pasta with chickpeas and veggies. S and I have been having Sunday lunch in Toronto / dinner in Paris. It's a nice way for us to unwind at the end of the week with a glass of wine and reconnect by cooking something together. 



I've been doing a lot of baking this month since my dad has been visiting, he's been doing all the food shopping / meal preparation and my only responsibility is for the bread we have for breakfast everyday. I've been trying out different scoring patterns. 


Here I was inspired by the shape of a rose


I made this pumpkin bread for Canadian Thanksgiving. I couldn't find any kitchen string since I think everybody had bought some for tying up turkey! I used garden twine instead and it worked surprisingly well, though some people may have gotten some extra fibre... My favourite part about making the bread was stealing a stem from a zucchini! 


Take two, used a walnut for the stem instead and used more pumpkin (about 25% by weight). I think this scoring worked out better. 


Here's a sneak peek inside the pumpkin, the bread had a beautiful orange hue and had a wonderful fluffy texture, stuffed with pepitas.  

On the road... 


I took my dad and his partner on a big road trip in October. I was going to Montreal for a conference so we made a trip out of it - we went to the Thousand Islands region, Montreal, Quebec City and stopped off in Ottawa on the way back. There were lots of farms along the way (we took Highway 2, the "old" road passing through small communities) and here we saw some weird and wonderful gourds at one of the roadside stalls. 


A rice cooker is essential for all Chinese families on road trips. Not only can one cook rice but it is also used as an impromptu pot for cooking all sorts of things, like soba! Here we had the soba with home made radish & carrot pickles, and a topping of pork & shiitake mushrooms slow cooked in soy sauce and bean sauce. 


Not strictly in my kitchen, but take a look at this incredible poutine we had along the way, in a fromagerie near the original home of poutine in Drummondville, Quebec. The cheese was fresh and squeaky, the gravy a little on the salty side, but the fries were perfect - some were crispy and crunchy, others were saturated in gravy. Delicious!


And who can visit Montreal without going to get bagels? There's been a big rivalry between St Viateur and Fairmount, I must say I prefer St Viateur by far. The Montreal bagel is a little more dense and sweeter than the New York bagel, as it is cooked in honey water. They are simply incredible when warm straight out of the wood fired oven. 


This was a gorgeous soft brie cheese we picked up at the fromagerie in the middle of nowhere in Quebec. As good as the cheese in France! 


I bought some cranberries thinking they could be eaten as a snack. No idea they would be so sour! I cooked them with some honeycrisp apple (a Canadian specialty), and the colour was incredible!


After our long road trip of chasing the autumn leaves, we got back to Toronto just in time for Halloween. Here I tried cutting a skull shape into my bread but maybe he looks like a friendly one! 

Finally, my curve ball this month is one of the hundreds of photos I took on the road trip of the beautiful leaves... here was sunrise at Gananoque, the heart of the Thousand Islands. 


The sun rising over the St Lawrence river turned this maple tree the most extraordinary colour. Nature is just wonderful. 

I am sending this to Sherry of Sherry's Pickings who hosts the monthly In My Kitchen series. Thanks Sherry and have a good month everyone! 

Sunday, 2 October 2022

In My Kitchen: October 2022

One quarter of my fellowship year in Toronto has passed, isn't that just crazy? September was an intense month - S' mother came to visit us, my dad decided last minute to fly over from Australia, and then S went back to France for the first academic semester. We are back to long distance mode which is like a throw-back to the previous season of our relationship!   

The Zucchini Dinner

I love themed dinners and the idea of using one vegetable as the star ingredient... We asked S' mother to choose her favourite vegetable and she chose zucchini. We had a lot of fun planning out this special menu...  

Try asking a mathematician how many zucchinis one needs for a zucchini dinner!

These beautiful zucchini flowers were found by my friend at some gourmet shop somewhere.. 


The first course was my own sourdough, accompanied by slow roasted zucchini with balsalmic glaze. These were mouth in the melt tender and succulent after being roasted for 1.5 hours at low heat. 


The second course was the floral course. We made zucchini roses with thin slices of zucchini, and stuffed some zucchini flowers with a buffalo mozzarella and feta filling. The basil over the top came from our balcony garden.  


The third course was tofu and zucchini balls along with zucchini pickles. I've learned that pickles are such a quick addition to any meal, the tartness and crunchiness really lightening whatever you eat.  I would have finished with a zucchini chocolate cake but both S and his mum are not into sweets, so we had some fruit instead (not zucchini!)

Other adventures in the kitchen... 


Some extraordinary heirloom tomatoes we got from the Niagara region ... 


While the parentals were visiting, we all got together to make dumplings. It was a fun family activity and I can see why it's such a great Chinese family tradition. 


S and I made these fresh pork mooncakes on the last day he was in Toronto for the Mid Autumn festival. While most mooncakes people know about have a sweet sticky filling, I'm from Shanghai where we eat pork filled mooncakes.  


We made this short crust for the mooncakes, which was super interesting to make - two doughs incorporated together and laminated, kind of like a rough puff. 


This was not technically in my kitchen, but I just couldn't leave it out - What a lobster mountain! The one behind it is a crab mountain, and the fries at the bottom are the best, so umami and so crunchy... 


I had no idea that there were these grapes called Concord grapes in Ontario. E made a cake with them and also made a kind of grape confit to go over the top. It was our last musical reunion for a while until S comes back.. our little group has been having a lot of fun playing through the middle Beethoven string quartets. 



And well, it just wouldn't be my IMK without a loaf of sourdough, I'm experimenting with the scoring patterns again... 

This month's curveball... 

Ta-da! I finished this jigsaw just before the parentals got here. It was so much fun to do! I wanted my first jigsaw in Canada to be a Canadian one, and this one is of an Indigenous totem pole. I'm taking a break from jigsaws now since we don't have enough space for me to spread out (I was doing it on the dining table).  

I'm sending this to Sherry of Sherry's Pickings who hosts the monthly In My Kitchen series - thanks Sherry and have a good month everyone! 

Friday, 2 September 2022

In My Kitchen: September 2022

The evenings are cooler now in Toronto, and that is how we know the seasons are changing! S is going back to Paris next week for the first academic semester. It is incredible to think that we have spent the summer together here, we have so many wonderful memories. Next week will be huge for us - his mother is coming from Italy and my father from Australia, everyone will be converging on Toronto! 

In the garden... well not my garden

My friend E visited Australia in March 2020 just as the pandemic was starting. My dad gave her some bitter melon seeds which she smuggled back to Toronto and she's been growing them on her little high rise balcony since. These are the 3rd generation Australian bitter melons. 

These blackberries were growing in my friend's bountiful backyard garden - look at how luscious and juicy they are!

Some wild raspberries I found in nature's garden, while walking in a random green ravine.. 

From my kitchen.. 

This loaf was baked on a day that S and I were not having a good time. I slashed the dough like a sad face and it turned out crying! 

A stunning spelt loaf with walnuts, the hands make it extra special

I just had to take a photo of these colourful mini carrots before I roasted them with a honey garlic miso glaze!

And the peaches in Ontario are just utterly glorious, we have been eating them every day in August.. 

Onto the tomatoes...

I had a patient in August whose mother kept on bringing in baskets of tomatoes from her garden. Her daughter was just in her 40s but dying from cancer. It's hard to imagine what she was going through, and it was extraordinary that she thought of thanking the staff this way. We snacked on the cherry tomatoes (a most peculiar shape and vivid yellow colour) and I took some home to share with S.  

One night we had pasta with these gorgeous tomatoes, artichokes and fresh basil. 

This was a fresh and piquant pico de gallo tomato salsa we made for a Mexican tortilla night with friends. I love the flavour of those blue corn chips too!

Something happened to this bread dough and I had to turn it into a focaccia which turned out great with (very) caramelised onions and juicy pops of tomato.    

Last but not least, tomatoes are wonderful just as they are, on top of some pasta, strewn with buffalo mozzarella, fresh basil from our balcony garden and a glug of extra virgin olive oil. Fresh tomatoes are THE BEST. 

Thank you to my patient who has since moved on to a better place, I will remember you and your mum's tomatoes.  

The food and music resumes

The pandemic was a very hard time for everyone. For me, one of the greatest changes was the difficulties with playing music. I met one of my closest friends E when I lived in Toronto in 2016 - 2017 and before covid, we used to travel together twice a year, meeting up in random places to play music. In fact, it was on one of these trips in 2019 that we went to Paris to play music with S, and that is how S & I met. It has been so wonderful getting to play with her again and also catching up with other music friends in Toronto. It is one of the best things about moving back here. One day we got this pandan chiffon cake / walnut chiffon cake from a Singaporean shop, a memory of when she visited me in Darwin and we got pandan chiffon cake from Rapid Creek Markets. 

In August, we played through the five middle Beethoven string quartets (the 3 Razumovsky quartets, the Harp and the Serioso) along with E's brother - a huge achievement! I have been playing mostly viola, which suits me a lot. Another weekend, we played string quintets with another friend joining us, the Mendelssohn string quintet no. 2 in B flat major which S played when he was much younger at music school. Our souls are parched after the isolation of the past two years, and music has been what we desperately needed to quench the thirst of our souls. E is also a wonderful cook, and here she stuffed some of her homegrown bitter melons with a tasty mixture of TVP and shiitake mushrooms. 

Finally, the curveball.. 


The last time I lived in Toronto, I had moved here from Sydney. This time, I came after living in Newcastle for 4 years. The difference is extraordinary - now I find that my soul constantly needs green and yearns for nature. I've been going into the ravine whenever I can, just so that I can try to recharge my soul. On one of my walks I went to High Park - some corners of it are really busy and popular, but other areas are totally deserted. What a magnificent green oasis in the middle of a busy city - here is the Grenadier Pond on a rainy day. 

I'm sending this to Sherry of Sherry's Pickings, who hosts the In My Kitchen series - thanks Sherry! 

Friday, 19 August 2022

Three recent dreams

The silent concert

In this dream, I am with three other people in an apartment I do not recognise. One person is my music friend L who lives on the Gold Coast, who has always been very encouraging. One person is my other music friend W that I played piano duets with often in Sydney, who is quite an eccentric character. The third person I do not recognise at all, a lady in her late 40s or early 50s perhaps. 

There is a piano in the centre of the room that we are in. We take turns going up to the piano and playing short pieces. I play a waltz by Chopin, someone else has a turn, then I play some light jazzy number that I don't recognise. The others play little snippets of Mozart or Beethoven. The atmosphere is relaxed and we are enjoying the music together. 

Then L suggests that I play a violin-piano duet with W. (In real life I haven't played the violin much in recent months, because I mostly play viola or piano now). W is really enthusiastic about the idea, and we get out a book of Beethoven violin sonatas, something that I am really familiar with due to my real life Beethoven project with a different friend, though I haven't studied any of the sonatas in detail. 

I open my instrument,  a violin that I do not recognise. Whose violin is this? I wonder to myself. 

We open the book and it falls to number 5, Spring, the most famous of the Beethoven violin sonatas. I tune to the piano briefly and W looks at me expectantly, waiting for the cue to start. 

When I start to play, I hear that the sound is all distorted. It is as if I am taken back to the beginning of my violin learning, more than ten years ago, when I could hardly pull a bow across the strings and make it sound even remotely reasonable. The sound is really scratchy and I feel very exposed. 

Suddenly I realise that there is no sound of the piano. I look over at where W is playing the piano. I can see his fingers moving, his body moving, but I cannot hear anything. I look over at the other two ladies and they are entranced by the music, bobbing their heads up and down in appreciation. 

What are they hearing? I ask myself. 

The sound that is emitted from my strings is worse and worse, barely distinguishable and totally out of tune. It's as if a cat was playing the violin. I start to panic, and I hope for a reprieve from a piano solo, but the piano is totally silent. I cannot hear anything at all. 

When we finish, the ladies clap and cheer enthusiastically. L says that we should perform somewhere. 

Perform? I ask incredulously. How can we perform like this? 

She scrolls through her phone to find an event that we could perform at. She stabs her finger at certain music festivals - What about this one? 

Then I wake up. 


The path to France

In this dream I am walking on the street when I bump into a friend that I met when I was travelling in el Salvador in 2016. She is with my friend from university that I have lost touch with for a long time. They both have extremely long hair, which is not like their usual hairstyles. I have no idea how they know each other in the dream but they seem to be very friendly with each other. 

When I bump into them, they are both re-doing their hair. Their tresses are so long and silky that I stop to admire their hair. (In real life, my hair has been undergoing a disastrous transformation during covid). They greet me enthusiastically and ask me if I am ready for the big trip. 

The big trip? I ask them in confusion. 

We are all going on the big trip together! They announce almost in chorus and giggle. 

I go back to my apartment in the dream, somewhere that I don't recognise. S is there, packing things. I guess we are all going together. 

We each have our backpacks and we go down to meet the two girls. When we get there, there is a big trail sign with the map of where we are going. They point to the campground where we are staying. 

No way, I'm not going there. S says. 

At that moment I realise that he has never said something so definitive to me in our real life. He usually beats about the bush and says a lot of other things before either having the truth extracted (because I am so impatient) or getting there through a series of complex oblique references. 

OK then, we won't go there. I reply. The other girls have disappeared at this point. 

We look at the map of the park together, and towards the eastern side of the park there is a trail that is marked with a dotted line, indicating a footpath only. 

It is then I realise that all the signs on the map are bilingual, in both English and French. But that last trail I see on the eastern side only has French. Then I realise that it is the path that takes us all the way to France.

This one? I ask S. But he does not reply and I wake up. 


The death of the child 

In this dream, I am in the ICU, one that I do not recognise. It's not one that I have worked in or visited. GF is there, one of my old colleagues in Sydney. 

He apologises to me profusely for handing over "a mess" to me. He explains the situation - it's a boy who has had a catastrophic brain injury and he is now brain dead. The parents do not want the life support to be discontinued, but they have accepted that today is the day it will be done. Of course he feels bad that he cannot carry it through, but I have taken over the clinical service today so it is my turn to look after all the patients in the ICU as per usual. I say a cursory "no worries, I'll take care of it" kind of thing and leave my colleague. 

I go into the room. The boy's parents are there, and one other woman who I soon understand to be the sister of the mother. The boy is lying inert in the bed, a boy of approximately 6 or 7. He is ventilated and has the usual ICU equipment on him. 

I start to say my usual spiel of "I'm sorry for the situation you are in... " and try to get an understanding of what they understand will happen next. The parents are silent but the aunt of the boy starts to cry. 

Unusually for an ICU, there is a desk with a large mirror in front of it, a mirror which perfectly reflects the situation. I see the boy in the bed and me in blue scrubs next to the bed, with the aunt standing next to me. The parents are at the foot of the bed and cannot be seen in the mirror. 

I become aware of a chair in front of the desk. Draped over the back of the chair is a beautiful dress, a cream coloured silk dress with a delicate floral pattern with pinks and greens. I wonder what the dress is doing inside the room and what it means. 


(Image borrowed from Google, not from the dream!)  

After a moment of taking in the desk, chair, dress and mirror. I start to examine the boy. 

I introduce myself and then ask "Can you show me your thumb?" My standard opening neurological examination question.
 
I'm not expecting him to move at all since my colleague had said he was brain dead, but I am convinced that he did move his thumb upward slightly.
 
Shocked, I ask him "Can you show me two fingers?" My usual follow up question.
 
He shows me two fingers, more definitively this time. 

I feel the weight of the silence in the room. I feel the eyes of his parents and aunt boring into me as I struggle to think of what to do next. 

"What's 1 + 1?" I ask the boy. 

He holds up two fingers again with his left hand. 

I hear a sob erupt from the mother, she buries her face in the shoulder of the father. 
 
I look back at the boy and I struggle to think of what is happening - how can a brain dead child suddenly be responding in this way? 

Suddenly, two nurses come into the room, pushing a stainless steel procedure trolley, the type we usually use to insert vascular lines in ICU. On it are a selection of surgical instruments, laid out neatly on a sterile drape. 

"Hurry up, doctor." The nurse closest to me says. "They are waiting over there."

"Waiting for what?" I ask. 

She doesn't reply and she starts to undo the tapes around the boy's mouth to take the breathing tube out. 

"Hang on a minute here." I move to stop her, putting my hand over hers. "This boy is not brain dead."

"It doesn't matter." She says and wrenches her hands free from mine. "They need his kidneys over there."

"But he's not dead." I say, my voice echoing around the room.

At that moment the aunt lets out a piercing scream and I wake up. 

Tuesday, 2 August 2022

In my kitchen: August 2022

And just like that, our first six weeks in Canada have flown by! 

A friend remarked the other day just how big the life change has been - new country, new apartment, new job, new specialty, new hospital, new moving-in with a partner.. even new flour can be challenging! Even with the ups and downs, it truly has been the most wonderful time and I could only hope to capture some of it in this post.


Unfortunately our balcony only gets afternoon sun and my attempts to grow lettuce and radish have been thwarted, nevertheless we started this cute little herb garden.


I don't think I'd even had sage before trying this "traditional" Italian combination of cannellini beans, zucchini, garlic and sage with a healthy slug of olive oil. 


We have been eating lots of the Asian foods that I missed while in Europe. I bought a tub of gochujang and made a spicy soup with vegetables and tofu, served over sweet potato noodles. 


I'm totally obsessed with these thick hand-cut noodles, here I had them with some radish and my friend's fish-head curry without the fish-head (a bit too much for me!) 



I'm very pleased to report that Barney is now doing very well in Toronto and seems to have adapted to the local conditions.  What a resilient boy he is!


My friend brought us a bag of traditional Montreal bagels when she was visiting family there. Here is the quintessential Canadian breakfast for me, a few Ontario strawberries, a Montreal bagel and a slice of Uncle Tetsu's cheesecake. I know Tetsu's is everywhere now, but I will always associate it with Canada where I tried it first.


A lemongrass tofu banh mi from my favourite banh mi shop in Chinatown



For my birthday I had a zoom party with my dad in China, he invited some family and friends over in Shanghai and we had a slice of cake for breakfast here. It looks exactly like the cake emoji on your smartphone! The candles are on beautiful Huon pine coasters I bought from Tasmania. 



In the evening, S organised a wonderful surprise birthday party for me. He even got the concierge in on the action - he called from the lobby saying there was a parcel delivery and when I went downstairs my friends jumped out from behind a pole! My birthday present was playing the Dvorak piano quintet, what an extraordinary treat with musical friends. We only have 4 chairs so the upper strings had to stand and the audience had to sit on the bed, what a memorable experience! And these were my birthday desserts - a light-as-air lemon cake and a gluten-free trifle with cherries and blueberries. 


And now that we have made dumplings in our new place - these were with a filling of napa cabbage, tofu and red capsicums flavoured with sesame oil and ginger - we have truly moved in and christened our place our own. 

Finally, the curveball... 


I moved out of home in 2001 and haven't had a piano since. The piano I played when I was a child is still at my dad's place. When S and I moved into our new place, we thought about renting a piano. In the end we just decided to buy this, a cheap and cheerful Yamaha electric piano. Of course it's not a forever piano but the finger-touch is surprisingly good and it serves us just fine for our purposes. We have been playing through the book of Mozart violin sonatas, choosing a different one to play everyday before dinner. It's a wonderful way to mark the end of our busy days and to relax into the evening. Everyday we are reminded of how fortunate we are to finally be here together in person, and also how fortunate we are to have this extraordinary connection through music. 

I'm sending this to Sherry of Sherry's Pickings who hosts the monthly IMK series - thanks Sherry!