The story of Mr C

I first met Mr C in March, when he was admitted for the third time with anaemia. His story was ominous – he’d lost weight, had trouble eating and intermittently vomited. He was one of those eighty year olds with a handful of medical problems that had troubled him for a long time, and it looked to me that something big was just about to be discovered.

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.

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.

Goodbye violin and Kody

A belated goodbye to my dad's violin:

You started life in a slaveshop somewhere in China in 1961. Who knows what conditions you were born into but someone evidently loved you enough to hand paint the year of your birth inside the bow.

My dad bought you as a 18 year old boy full of hope about life, but couldn't use you to play much more than revolutionary songs endorsed by the government. He soon got caught up in the rest of his life and you went to sleep quietly in your case, watching the seasons come and go.

You lived for so many years atop a cupboard, surviving every cleanout at my house, and eventually made it to Sydney in 1996 after my dad almost got arrested at the airport for jokingly claiming that you were a machine gun.

In 1997 I tried to play you for about three months, but gave up because it was just too hard.

Then you went to sleep for another 12 long years, before I decided to wake you up again. I had all your mouldy bits replaced and you came back to life, vibrant as ever.

You served me for a wonderful two years before you choked to death in the humidity of Darwin. Unfortunately the moisture expanded your neck until the head snapped off from the body, much like a cervical spine fracture.

But you helped me to learn my scales, studies and a handful of decent pieces. My favourites were - Salut d'Amour, Tchaikovsky's 2nd movement of the violin concerto and Mozart's G major concerto. You helped me to realise my dreams of playing the little things I always wanted to play - Schindler's list, swan lake, Air in G...

You were with me for so many good times. Lessons with Trish for a year, the Scottish Fiddle club, long nights in Nowra in that lovely resonant living room, and of course in my little Darwinian bunker.

Thank you, you have served my dad and I very well. I hope you rest in peace in violin heaven.


And to Kody:

We always knew you were going to be too hyperactive to be a guide dog, but somehow we just prayed that you would grow out of it, and grow up to be a great guide dog. Alas, it is not to be, and your life must go on like a normal dog's.

You are such a bright happy boy, I'm sure you will love your new home with a family who needs a dog just like you. Hopefully they'll have little kids that will grow up tugging on your tail and playing ball games that you love, or maybe an oldie who just needs a friend to walk with everyday.

I'll always remember how you dug up our entire backyard, ate the doormat bit by bit over six months, found my dad's wallet which was lost in 1997, and pretty much cleaned out all the junk under our house in Nowra.

We had so much fun together, but it's time for you to go to another home. Have a good life Kody!

A random Sunday in Darwin: Nancy vs. the wasps, and masala dosa

On this fine Darwin morning, I decided to dismantle the mound of some random thing outside my door. About two weeks ago my neighbour Chattu noticed it was getting bigger, and kicked it with her foot. At the time she said "ew, there's soft stuff inside" so I thought it was probably pretty benign.. it's just all mud, right?

Anyway, I thought I'd take it down with the broom handle. I whacked it a little, and it was rock solid.
So I whacked a bit harder, and the top chunk flew off across the lawn... revealing a collection of bright green wriggling maggots.

At this point an angry mother wasp which looked comically huge flew out of somewhere and attached herself to the slightly de-roofed mound. As I whacked at the mound a bit more, she buzzed around me trying to get me, but I managed to scare her off by waving the broom madly and shouting random insults.

As I revealed more of the mound, it was actually like an apartment building full of baby wasps. It was bizarrely fascinating, with the life cycle of the wasp completely illustrated. There were tiny green grubs, which turned into big green grubs, which then lightened gradually till they became big fat white grubs. They all looked so incredibly gross, like something out of a dead body. As they crawled all over the ground, I ran screaming to the garden hose and started blasting the bits of nest and grubs.

As I furiously hosed the piles of wasp apartment rubble, the mother wasp started dashing around me like mad. I wasn't sure up till then if wasps had feelings but she managed to communicate "get lost!" pretty well just by buzzing. Soon there was nothing left but a pile of grub bodies, and a very sad wasp that limped away to make her nest somewhere else...

And through all that there was but a single thought in my head (other than kill! kill! kill the wasps!)... am I allergic to wasp stings?

 The remnants of the wasp nest

Wasp nest dismantled, I went out for lunch at Saffron, a flashy Indian joint in Parap. On Sundays they do a special South Indian menu with the staples like dosa, idli/vada and oothapam. The masala dosa was perfectly done, crispy one end and slightly soft the other end, with a solidly flavoured masala potato stuffing. The chutneys were pretty damn good too (chilli, mint and coconut), and the sambhar satisfying, though the serve really was very small. Chattu had a chicken dosa, which strangely was stuffed with tandoori chicken. Afterwards there was mango kulfi and carrot halwa, which reminded me of those days I used to stir it in my kitchen, filling the whole house with the smell of sultanas and cardamom.

Sri Lankan hoppers... and symphony in the rain

I went to the Buddhist food festival today. The Buddhist society of Darwin has its grounds in the northern suburb of Leanyer, a fair way from the city but pretty close to the hospital. I was shocked to see that half of Darwin had rocked up to the food fair and festivities, like seriously, Darwin and Buddhist in the same sentence?

 Stupa at the Buddhist centre

It took about half an hour to get to the head of the line and get my hoppers, which were cooking very slowly as there were half a dozen women there but the hopper cooking wasn't very co-ordinated. Nevertheless the aroma of the hopper batter as it cooked was so enticing that I kept standing in line anyway.

Hoppers are like bowl-shaped pancakes made in a special hopper pan. The batter is made of rice and coconut milk, and must be fermented as it slowly bubbles as it cooks. The egg hoppers have an egg cracked into the middle too, and cooked  to just right with the lid on. These hoppers were served with a piece of chicken curry and a very spicy sambal cabbage.

I also picked up some cendol just as it was about to run out, and these were deliciously sweet with coconut milk and palm sugar. The slippery pandan noodles were homemade and thicker than usual, which made them slightly more chewy, which I love. This was so perfect for some content slurping after the hoppers.

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Last night I went to Darwin Symphony Orchestra's second concert of the year, where they played Sculthorpe's Beethoven variations; Mozart's violin concerto no. 5 in A major and the Pastoral symphony by Beethoven. It was an ambitious program for a community volunteer orchestra and they did remarkably well.

It was beginning to storm as the pre-concert talk started. Most other concerts I've been to have had so very formal pre-concert talks where the discussion is based on the background of the works to be performed. In Sydney the talk is usually given by prestigious musicians or others in the field, but Darwin must be Darwin... so we sat around on plastic garden chairs under a pergola in the Indonesian garden at Charles Darwin University, and geckos climbed on the wall all around us. Only about 30 people showed up for the pre-concert talk so it was very informal and the speakers didn't even need a microphone!

The concert itself was held in the auditorium at Charles Darwin University, which had an uncanny resemblance to the hall at Fort Street, where I sat many a time (mostly on the stage as I played the national anthem and school song most assemblies). This is the first concert I've been to where the national anthem was played prior to the concert, and it felt even more like a school assembly! Most people stood and sang, which was a nice touch.

The Sculthorpe was a hard one to start with, as the dissonance was received with many puzzled looks in the audience. Some started singing along to the familiar bits, and the crowd insisted on clapping in between every movement, which I thought was also quite Darwinian. Where else would you rock up to a classical concert, have half the people around you in shorts and thongs, and even have some bring their own beer to drink?

Katie Betts was stunning as the solo violinist in the Mozart. The orchestra played well but she made her beautiful instrument sing, and I think everyone was pretty impressed.

It was pouring as we went to intermission, and the courtyard outside the auditorium was intermittently lit by the flashes of brilliant lightning. The rain fell steadily and the air was filled with a moist sweet scent. As we sat down to the second half of the program, Katie suddenly turned around and said "Where else but in Darwin would we hear the Pastoral symphony, accompanied by the rain and the sound of crickets?" It is so true, where else would one hear the sounds of the storm outside alongside the musical storm of the Pastoral? I have heard the Pastoral so many times in my life, but this was a pretty unique one that will stay with me...

Dream: the unfinished violin

I'm walking into UNSW from the main entrance on Anzac Parade. As I walk down the main walkway, there are a number of stalls on the left hand side, much like the night markets or O-week activities that are often held.

One stall with lots of instruments catches my eye. It's a bit dark and there's a very tall man in front of me blocking my vision, but still I can make out a handful of mandolins. The stall owner calls out to me to ask if I'm interested in anything, and I randomly point to an instrument.

He takes it down and it's actually a nice looking violin, but it's not finished - the wood is raw and unprocessed, and the violin is not polished at all. Somehow in the dream I'm thinking the wood is probably silver beech. It feels heavy in my hands, and also a bit rough to the touch. I gasp at the price tag of $35,000 and start to hand it back to the stall owner.

"Try it, you'll love it." He says and offers me a big cardboard box full of bows which are also unfinished. I randomly pick one which looks like it's made of the same wood as the violin. The tag on it says $2,000.

In my mind I'm grumbling about how expensive this unfinished violin is, but my fingers find their way to the fingerboard and I start to play the second movement of Tchaikovsky's violin concerto. The beautiful clear sound completely blows me away, and I am stunned by how wonderful this simple unfinished instrument sounds.

The lower strings are the best, but every note resonates with perfection.

The G string is dark and sombre, like an inky dark night.
The D string is deep and sonorous, like a vibrant tenor voice.
The A string is full of warmth and brightness, like the rays of the morning sun.
The E string is perfectly smooth, like running one's hands over silk.

I fall completely in love with the violin and put it all on my credit card (maybe next life I'll have such a huge credit limit...).

The next scene warps to my "home" in the dream, which is a townhouse I don't recognise. I share the place with a Japanese girl who's not there, and there are Japanese things everywhere - a kimono draped over the couch, Japanese fans on the walls, a teaset. A Caucasian girl with blonde hair and blue eyes comes into the room and brings in her laptop, on which she brings up a Chinese website for comparing violin prices.

Here I lose recollection of the dream (which is highly unusual for me as most vivid dreams are retained in their entirety in my mind). I had written "toilet rolls" as the last keyword but I cannot remember why..
 

Random Darwin photos

My new favourite word since moving to Darwin: random.

Really, there's no other way to describe half the things that happen up here. Sometimes there's not much to do but shrug and say oh well. 

Like when a patient shows up with this in their file..

Or when a patient shows up saying they passed out after being hit in the head by a mango.
Or bashed with a didgeridoo.
Or when they rupture their spleen coz a boomerang went off course.

What do you actually say to all that? It's just normal for Darwin. 

Also part of the RDH ritual is the daily pages from administration imploring us to discharge patients. These usually run along the lines of "Bed block, 25 patients waiting for admission", or "Bed block, 30 beds needed for elective surgery TODAY". But I received this amusing page last week:

This random ward mascot (for the infected ward) fell off its perch and landed on my notes one dark night when I was trying to write in the notes. An ode to infection, which is just really part of everyday life at RDH. Never before have I scraped a patient's skin before sending them to CT because of suspected crusted scabies!

Random things do not only happen in the hospital.. the community is full of them as well. I'm sure there are many people around Darwin who collect headlines from the NT news, which must be the most entertaining newspaper in Australia. Where else would front page news be "Mayor says kill cane toads" or "Crocodile run over by car"?

Even the good old Asian store had a surprise amongst the rows of spices and sauces..

Enough random photos. The experiences I've had since moving here remind me so much of the fact that I live such a normal life in Sydney. I go to work, catch up with friends on the weekends, watch a movie occasionally, eat at my favourite places or check out a few new places... but I hardly ever step out of my comfort zone. I've made my square and I don't step outside it.

Since I don't know anyone up here, I've been so much more open to random experiences than I usually am. Meeting strangers seems to be all part of the Darwin experience, and everyone just brings their friends along to every random thing. Some of what's happened so far has actually had me wondering "is this really happening?"

Like when I went to the Waifs concert, the first pop concert I've been to in about a decade. In actual fact I've never been to this type of concert, even back in the days when I used to listen to this type of music (hmm.. I guess in high school). In Sydney I would have just said nah, I'd rather stay home and read a book, but since half the hospital was going I thought it might be a fun way to spend a Saturday night. So we ended up sitting around plastic tables and chairs (in true Darwin fashion as anything made of plant material would just turn into giant lumps of mould), drinking and waiting for the Waifs to start. When I was in the moshpit I wondered if I was really in a moshpit at the ripe old age of 27, especially since I've never been in a moshpit! With battered eardrums I retreated to the beach with Susan, which was filled with people sitting in campchairs around impromptu campfires and billies! I don't know what they sell at concerts in Sydney, but in Darwin one has the usual hot dogs & pies alongside chicken curry and rice (how does one eat that when one is drunk??) and what my eyes immediately rested on - an entire roasted lamb shank. So as I sat on the rocky beach watching the stars and gnawing at my giant lamb shank (which looked like it could cause some serious injury if I chucked it at someone), I had but one word in my head... random.

Last week I went to the monsoon markets with Chattu and while sitting there eating our Cambodian pancakes and green papaya salad a girl came up to us to borrow one of the unused chairs at our table. We soon realised she was an elective medical student from Monash and Chattu had worked with her sometimes in ED. Romy invited us to join her table, which consisted of another med student, her cousin and her grandma! Her grandma was really cute, and very quick-witted with a sharp tongue to match. She invited us over to her place to play rummy and so in typical Darwin fashion, we soon found ourselves in the student dormitory at Charles Darwin University, collecting random snacks and the set of rummy tiles that her grandma brought over from Melbourne (she was only visiting for a week!). As we sat in the student common room, eating custard with Maltesers and some Jewish pastries, playing rummy with Romy's colour-blind cousin and hearing Jewish folk tales from the grandma. How random is random? The way Romy talked reminded me a little of Tamara, and somehow I felt like I was back in high school again, at Tamara's house playing board games...

Last night the randomness continued. I was hanging out at Young's place, and was initially planning to go home because I was so tired from working so much. She and her Botswanan flatmate were going to a BBQ, but he decided not to go at the last minute so we ended up going there together. Half of Darwin's French population must have been there, and when I walked in something in my mind exclaimed "so many froggies!" Somehow it reminded me of the two froggies I met in Bolivia, whose names I can't even remember. They take their cooking pretty seriously - a BBQ doesn't involve gas, or the charcoal thingos you buy in a bag from Woolies - for the French, they had chopped wood to burn down to charcoal, which they then used for the BBQ. The whole process took a long time, but when dinner was served it was worth the wait. We had grilled vegetable skewers, marinated chicken skewers, sausages and old-style hamburgers, which were all rustic and delicious. Also in with the charcoals went some potatoes in al foil, which was served with butter and Japanese Kewpie mayonnaise. How random is that?

One last little bit of randomness, I went to the library to return books today, and bumped into my medical student doing an assignment there. She must have thought my impromptu invitation to go to the Happy Yess (or is it Yess Happy) markets pretty odd, but she decided to come anyway. So we ended up at the markets which were held in a homeless looking park in the city, watching the hula hoop selling lady and all the people and dogs walk past. We sat on milk crates at colourfully painted tables as we ate Timorese poppi (looks like a pluto dog but made of chicken) and fish cakes with fried shallot and special sweet sauce. The cheerful lady who served us described their restaurant (Laksa House) as "on the highway, right opposite Sexy Land". (Oh how I love Darwinians..) Then we rifled through the piles of junk for sale, and Maggie went home with an armful of clothes for $20. 

I love the randomness of my life up here though, and I'm sure it's going to get even more random.