Goodbye Darwin

I feel like I've only just arrived, but here I am on my last night in Darwin already!

I have been so incredibly fortunate to have had this amazing year in Darwin - amongst so many things that I will remember about this place there have been some highlights.

Living in a beautiful tropical house with Johanna, Pete and Namiko - I loved this place from the first time I saw it, with its high ceilings and bright airy feel. Never mind our problems with ants, or rats (we only managed to catch two, one dead under the washing machine and the other in a trap that I named Patsy), or spiders.. we did have the occasional cane toad and some very cute green tree frogs too. Having a lovely place to call home was definitely a nice setting to my year in Darwin.

Cool people tend to be attracted to Darwin, it is a law of life that I found out pretty early on. So many doctors (and other staff of course) in the hospital have done different things with their lives - most have travelled, many have worked overseas, lots have different hobbies outside medicine.. It's made for such an interesting year of getting to know people. I was pleasantly surprised by the likemindedness of so many people - lots of hippies and free spirits, dreamers and roamers - I fit right in!

East Timor was a true highlight - Being on deserted Jaco island with the perfect shimmering turqoise water alongside a strip of fine white sand was the epitome of the dream holiday for me, but the truly special moment was when I saw coral reef and tropical fish swimming in the ocean for the very first time. It has motivated me to learn to swim - thanks to my housemate Namiko (and Chatu and Megs), I'm slowly making some progress out of the drowning stage. I never knew the ocean made little clicking sounds (it's the fish talking to each other!) and I really want to hear it again, and see those fish again. Maybe one day I'll go diving...

Mango season was insane too. I will never forget getting up on Sunday mornings (whether I had to work or not!) and going to Rapid Creek Market to buy mangos. There was one particular stall run by a Vietnamese family that I went to every week, and there was one week I bought 10kg of mangos! Eventually we chopped some up to freeze, and so long after mango season finished we were still enjoying mango smoothies.

Camping out at Edith falls, we walked up to the top pool and had the whole waterhole to ourselves. It was an amazing breakfast alongside the beautiful pool with a little waterfall at the far side. The next day we bought a giant watermelon in Katherine and camped at Katherine gorge where the sunset over the river was a deep dark orange. Kayaking in the gorge was one of the most fun things I did this year - it was so pretty that I felt like we were kayaking into a postcard. I love lots of tropical plants but the pandanus trees alongside the gorge had to be high up on the list.

Markets are part of the lifestyle here - I would go to Rapid Creek most Sundays to get fresh fruit & vegetables, and I loved the feel of being able to buy local produce that was in season, chat with the people who grew the vegetables while touching and smelling everything. Parap was often a Saturday haunt, and I'm faithful to the BBQ pork on a stick stall and the laksa lady. Ironically, Nightcliff markets which were my original motivation to move to Darwin have not featured much on the radar because I usually go home or to work after Rapid Creek. I probably went to Mindil the most because Seetha loved it there - my favourite stall was the Happy Cow vegetarian stall, which sold lots of yummies including my favourite Cowpat (spinach & cheese pattie with a gooey inner).

The Darwin festival was a pretty awesome few weeks of fun and activities. Just hanging out at festival park on the lawn with the little wooden seatbacks was great, and there was one show that I really enjoyed - Wulumanayuwi and the seven Pamanui, a Tiwi adaptation of Snow White and the seven dwarves. The other shows were more so-so, but it was such a happening time in town.

I loved Deckchair cinema, and went as often as I could. There was something so Darwinian about watching the sunset, grabbing a plate of Hanuman's curry and rice, dousing oneself in insect repellant then sitting down to a film while the fireflies flitted gracefully above. There were so many stars in the sky that sometimes I ended up watching the sky instead of the movie.

A few friends came to visit, Elaine was first in June and we headed out to Kununurra together stopping to gawk at the giant boab trees which I adored. Lydia & Elsie visited in August and we spent a long weekend in Kakadu - I loved the sunset at Ubirr. Hsiang made a cameo appearance, then in October Shelley & Thu-ha suddenly showed up and I didn't even realise they were coming!


And.. I had so many memorable dinners that I could not even write them all down if I tried. The most prominent on my mind is probably the Christmas extravaganza at our house, involving way too much food (including a rhubarb crumble from MP!), Christmas carols and people playing silly instruments such as a crocodile xylophone. In a town where eating out options are somewhat limited, I've been blessed with eating lots of excellent home cooking. I will never the freshly shucked oysters at Matt & Jerome's, they were just the best..

The dry season - is there anything better than the dry season in Darwin? Crisp blue skies, beautifully cool nights, wonderful sunsets. But even the wet season has its own appeal, with the huge thunderstorms and lightning that slices through the sky. We almost had a cyclone, but it got lost on its way to Darwin..

Last but not least, the patients and the pathology at Royal Darwin Hospital have been absolutely amazing. I have seen so many outrageous things that it almost seems normal to me now. I was lucky to have gone on outreach to Tiwi, Katherine, Gove, Groote Eylandt and Minyerri, flying around on those little planes ducking the storm clouds. On our way back from Groote, we flew over the Kakadu escarpment and saw Twin falls and Jim Jim from far up in the sky - it was awe-inspiring.


I have enjoyed Darwin so much that I feel melancholic about leaving. At the same time I know the experiences and memories will stay with me for a long time, and I'm so glad to have met a few friends here that I might keep for a while. With everything that ends comes something new, and the next chapter of my life is about to start in Sydney. So... goodbye Darwin, I hope to be back again some time!

Dream: a drug ring bust by Will

In this dream I have bought a sky blue Nissan Micra. In the dream I shudder at my own poor taste - I think Nissan Micras aren't exactly the essence of style and am lamenting why I spent $20,000 on that car!

Anyway I pull up at the Woolworth's petrol station outside Casuarina. It's raining as I get out of the car to fill up. When I unscrew the lid, I see that the petrol tank actually looks like a big plastic bottle inside the car and the petrol just splashes in. I shake my head at the poor design and start filling it up. I look up and it only costs 70c/L! After a while I wonder how a Nissan Micra could have such a big petrol tank and decide to stop.

I walk inside to pay. The total is $54.25 and I hand the man at the till $55. When I get the receipt back and my change, I realise that the receipt is actually printed in Chinese and the items on it are completely random, as if I had bought things in a supermarket. Nowhere does it even mention the word petrol. I ask the man why I've been given this type of receipt and he says, just take it and go.

Suddenly it comes to me that this must be some sort of tax scam! I threaten to call the police and the man presses a big button on the wall. All these people immediately appear in the store and start calling things out over the PA system such that all the other cars in the petrol station scoot off quickly. I start to feel scared that I am stuck in this place with a bunch of thugs, but try to keep calm.

Then Will the ED consultant opens the door and he is standing there with his 5 year old daughter wearing a pretty pink dress.

"What are you doing here, Will? It's dangerous, you have to leave immediately!" I said.

"That's all right, I just came to save the day." He strolls in and picks up a candy bar for his daughter, who is very sweet.

"How? These men are really dangerous and they have guns!"

He hands me a copy of the NT news and says "The answer is there, as always, in the NT News".

I look down at the cover and there's a huge picture of a bunch of men being led away in handcuffs, and the title is Major drug bust in petrol station.

My spine chills and I wake up.

Haw Par villa

I had heard about Haw Par villa from my previous boss Tsin, who regaled me with tales of when he was taken there by his parents as a child in the 70s, when the place was all the rage for scaring kids into shape. Particularly gross sounding was the ten levels of hell, I knew I had to check it out for myself!

Built by the Tiger balm brothers (yes, the folks who invented tiger balm), it is a strange sort of Buddhist / Chinese theme park, where there were no rollercoasters but ethical and moral dioramas taken from old Chinese stories. As Singapore became more developed, it became less and less of a tourist attraction, slowly crumbling away in the south western corner of Singapore.

I was surprised to find that the new MRT line actually had a Haw Par villa station - I think it was meant to be. Some effort had obviously gone into restoring the place in recent years, and there were a fair number of families with little kids wandering around on the Saturday morning that I visited.

Most of the park consists of story dioramas and a really random assortment of statues which are just dotted around the place. Some of the staircases are fashioned into waves or caves and it was sort of eerie to walk around amongst these plaster statues that were built almost a century ago.

I had a great deal of fun making up captions for some of these dioramas:

Yellow and red don't go together!

Life is more fun with three!

You never know what skimpily dressed woman you might find inside a giant clam shell

 
There was also the most bizarre animal park, where three giant gorillas (about twice my size) sat down one side on a fake log, and the rest of the park was dotted with scared looking animals including some real menacing looking kangaroos (!), a few kiwis pecking at the lawn and this tree of koalas.

A few monuments to the Aw (Tiger balm) family were scattered around the park, and the centre of attention was this lake filled with turtles.

Other surprise finds included the weirdest diorama of a badger hospital (this badger doctor is obviously a vampire)

And also this Tiger car, I guess it'd be hard to lose in a carpark!

But of course the real attraction was the Ten Levels of Hell, which was inside a dark building of its own. It was barely lit inside by a dim red glow, which made everything look extra bloody. I think the sign outside warning that the place is PG should probably be extended to adults, especially after I'd read that being stuck on a mountain of knives is punishment for tax evasion!

It's so oddball that it's almost not gory, but there sure was a lot of blood in hell...

The solution? Well, one could dance around some Tiger balm 

or alternatively just follow this helpful plaque at the exit (topped by a skull with daggers coming out of its eyes): The sea of suffering is endless, just turn around and the shore is there.

What a weird place. I loved it!

An unique outreach

So there we were on a remote island, a couple of hours flight from Darwin. We had arrived on our own little charter plane, crossing a crescent of deep blue ocean onto a lushly wooded island. The clinic was practically closed as there was a death on the island the day before, and everything was in lock-down mode. It appeared as if we had fatefully chosen a bad day to come to the island (and we only visited three times a year!)

We spent most of the morning seeing just a handful of patients. As we were having a cup of tea and getting ready to pack up and call it a day, a nurse ran into the tea room and shouted "We need a doctor! Emergency!"

It was almost a little surreal, as the tearoom really felt like someone's lounge room, and it didn't seem like we could be called to attend an emergency in such a cosy relaxed place. But as we ran outside, reality sank in - there was a landcruiser with a handful of locals, shouting and gesturing frantically at the motionless figure sprawled across the backseat.

For a split second my brain froze as I thought it was the lady I had just seen in clinic, but as I got closer I realised it was someone else. She didn't appear to be moving at all. My boss started doing chest compressions and all of us together managed to get her onto the trolley to move her inside the clinic.

Inside we realised that she was in a terrible way, and that she was probably "gone" as convention would say. Her heart had gone into a seriously abnormal rhythm and was unlikely to recover. We carried on the resuscitation, knowing the grim prognosis at the back of our heads. We looked at one another sternly and decided on ten minutes as a cutoff point, thinking that everything would probably end there and then.

Ten minutes later we were surprised to find that she had started to show signs of life. So we kept going, and going, and eventually got to a point where we had to make a decision to evacuate her to Darwin. It was a bad day to fly - Darwin was a no-fly zone because Obama was in town, and we ourselves had even seen the giant US airforce planes parked across the runway at Darwin like alien spacecraft as we took off in the morning. Careflight took several hours to come, and things had taken a serious turn for the worse during that time, though she was still alive.

I have never been called upon to bag ventilate a patient for four hours. The repetitiveness of the muscle strain aside, my mind was adrift in a sea of thoughts, about what had happened during the resuscitation, about what would happen to the patient once she made it out of this place (or would she?), about all the things that we didn't have on hand at the clinic.. about all the ways things could have been better.

But there was nothing I could do, other than rhythmically squeeze that bag. It was almost hypnotic, watching the oxygen go in and out. Eventually when Careflight came it felt like there were so many people in the room it was almost like a circus. As we got ready to leave the clinic, I looked outside and it was completely dark. There were dozens of faces in the front yard peering anxiously inside the security fence, and beyond those faces were even more, spilling out onto the main road. We drove to the airport and there was a crowd there too, all lined up along the fence near the Careflight plane. It felt like half the community was there, and though everyone kept quiet, it felt like a potentially unrestful situation.

Later I heard that she passed away in intensive care, which was more or less the expected outcome. Though she'd fought the odds to come back, the time before she got to the clinic that her heart had not been working and the long time it took for her to be retrieved, meant that she didn't really have a chance at long term survival.

I had never done an out-of-hospital resuscitation before, and getting to grips with the difficulties of being in such a remote location was certainly an eye-opener. A lot of things we take for granted in the hospital setting simply do not exist out there, and we were having to "make do" with what we had. There was a lot of thinking on one's feet, and given the circumstances I thought everyone involved did extremely well. On one hand there was certainly the feel-good factor that even in the community there were competent doctors and nurses serving the community, but there was also the sombre undertone that this is the harsh reality of life - getting sick 1000km away from the nearest major hospital is tough, and it's really touch-and-go. And not every community is going to have such a wonderful clinic, though it really makes one appreciate the work that remote health workers do.

A few favourite quotes

Patient with STEMI:  Doctor, I have this terrible pain in my chest, it's just like a buffalo is sitting on my chest!

Kirsty: Why would the surgeons even ask for an ECG? So they can fold it up and fan themselves?!

Dr Chacko (trying to explain to a patient going for a mitral valvuloplasty using a model of the heart): Guys, where is the mitral valve?

Patient with a stroke: my body was just swaying, like a tree in a cyclone

At handover, after 30 admissions: we need to marinate our brains in coconut liquor to continue

Dr McDonald: some patients are clearly obligate anaerobes

Dream: Johanna and the LV store

In this dream Johanna and I are a bit older, perhaps about 40. We are at a party where there are about 20 people and I don't recognise any of them except her, so naturally we start talking. She is wearing a pink striped shirt, much like the one I have hanging in my wardrobe right now, black pants and red heels. We are talking pretty excitedly about how I recently got married, and she berates me for never having introduced him to her.

"So here he is!" I turn around in the dream and see this short obese man, basically a conical Christmas tree shape with arms sticking out of a circumferential ring of fat. And I feel slightly nauseous.

"This is Tim Flannagan." I say to Johanna and feel shocked at myself in the dream. Me and some fat Irish man? What in the world?

They exchange some pleasantries and Tim waddles away.

"So what do you do with yourself these days?" Johanna asks me.

"Well, nothing really. Tim is really rich so I'm just a housewife." I reply and feel horrified at myself.

"Let's go to the LV shop then!" She suggests.

So we go to the Louis Vuitton shop in the city and Johanna says she is looking for a red bag to match her mother's red shoes. As she is browsing the bags, I see the world's most hideous necklace. It is made out of several circles of stone, a fungal shade of black-green. I pick it up and can see some bile coloured swirl inside the stone.

As I am staring at the yellow swirls, my alarm goes off.

Dream: a vomiting man and a water canal ride

In this dream, I am called to go to CCU to see a new patient. When I get there, there are hardly any nurses around and I walk all around looking for the patient. I find him in bed 1. A skinny old man, he is absolutely soaked in brown stuff that looks either like vomit or diarrhoea. More is coming out of his mouth in spurts and the gown and bedsheets are just totally covered in brown goop.

I turn away feeling nauseous, and find myself in a different scene. I am in Xiamen where I am meeting Marek and his friend Peter, who is a thin tall man with brown hair and brown eyes (no recognisable features to link him to anyone I know). They tell me that flights to Beijing are super cheap, only Y100 today. So we go to the airport and get on the next plane to Beijing.

On the flight I try to text star to tell him we are coming to Beijing but I find I have erased his phone number. I manage to find some pxt he sent me and send it to that number but the mobile doesn't tell me whether the message was sent properly. We take a taxi to star's place, which has warped back into his old place. Peter says he is exhausted and goes off to take a nap. So Marek and I are sitting outside in the living room when I suddenly realised that star is going to be absolutely furious if he came home and found that I'd let myself in and brought these strangers! So I tell Marek that we have to leave and go stay somewhere else, but he seems really non-chalant about it all.

Then the scene chops to a water canal town which looks like the region south of Shanghai. We are taking a small boat through the canal. The paddling is a little difficult at first because we keep striking things in the water, but we can't really see what the things are because the water is quite dark and murky. Then the canal broadens and we can see beautiful old whitewashed houses with grey slanting roofs on both sides of the canal. People are milling about doing their own thing. It seemed like the whole scene was in black and white with not much colour.

At some point we decide to go back and as we turn the boat around, gentle waves start to come down the canal. Our boat rocks a little, then the waves get bigger and water is splashing in. Marek says just keep calm and push on, so we paddle and paddle until we get back to the landing where we started. The stairs down to the water are completely flooded and we have to get out of the boat and swim to the top. We struggle to swim against the tide and whilst I can see the top of the stairs I can't quite make it there. Then I look up and there is a row of children standing on a balcony watching us.

Then the alarm clock  goes off and I have to go to work.