Harper:In your experience of the world. How do people change?
Mormon Mother:Well it has something to do with God so it's not very nice. God splits the skin with a jagged thumbnail from throat to belly and then plunges a huge filthy hand in, he grabs hold of your bloody tubes and they slip to evade his grasp but he squeezes hard, he insists, he pulls and pulls till all your innards are yanked out and the pain! We can't even talk about that. And then he stuffs them back, dirty, tangled and torn. It's up to you to do the stitching.
47 year old Patient with Narcissitic Personality Disorder (unofficially diagnosed by me a few months ago, but since then officially diagnosed by the psychiatric team when he turned up in hospital last week) comes in dressed in a fluorescent beeny and rock and roll outfit.
Patient:(talking about a nurse in the hospital)....You could tell she was the 'Wuthering Heights' type. Brawled her eyes out when I was talking to the doctor about my ex and I though oh god, here we go. She was hooked. Afterwards she came up to me and said all this shit about how nice it was to see me and sappy stuff. And I was going, hang on it's not like I was telling it to the registrar on purpose to make you cry or anything. What kind of stupid thing is that? She was drawn to me like a moth, I tell you. I mean, it's not my fault that my abs are so great, and I have these large painful erections all the time. I have to take drugs to keep them down. I'm so well endowed. I've had more women than most men can have in their life times. They're just drawn to me! I've slept with hundreds of gorgeous women. Models, famous actresses... even when I was on holiday, all these foreign women kept cracking onto me. I was like, my God, have some decency. They just wouldn't stop. And I tell you, it's because they're attracted to my incredible brain and my guitar skills and voice. I mean, I am pretty smart. It's not just the body. I don't have a job now, but I mean, I've beaten so many young bastards at scholarships, so I can do it again and get a degree anytime. But here was this woman...this nurse!...was just crying her eyes out over my story.
Dr. Lampel:So what was the nurse? Like Catherine? Who was the other person in that anyway?
Dr. Lampel:Do you know Catherine? And Wuthering Heights? Ever studied it at school?
Dr. Lampel (to patient):Do you think Melissa's a bit of a romantic too?
Patient:She's a romantic. But she uses pragmaticism to try and stamp it out, put it away.
Patient:That's right. I may be narcissitic, but I can know people.
So I woke up this morning with a strange feeling. It felt like the time I had the car accident and got a large haematoma on my upper lip, stretching it like a balloon. Except this time it was everywhere. My lower lip throbbed, as if I had shingles.
I tried to lick my lips and found they were replaced by Angelina Jolie’s.
What? Angioedema?? No way!! How could I have angioedema? I was supposed to go clinic that morning.
Options: 1) Immune reaction to something I ate/came into contact with. Unlikely, plus did not occur with urticaria or any other sites of swelling. 2) I sleepwalked into a wall with my mouth hard enough to create diffuse swelling (I quickly check my front teeth — no, still the same angle as the last time). 3) Mediated by illness. Stress related? No clue.
Anyway, feeling tired from having coughed the whole night, I decided to call it a morning. Clinics didn’t run in the morning anyway - I usually turned up to use their internet and surf when I was there, or read some of their textbooks in the office. I got put through to the psychiatrist’s answering message and left a message, sounding like I’d just woken up at 10am; worse, like I had spent the night screaming myself hoarse for one reason or another (more embarrassing than it sounds).
A moment of disturbance came when I saw one of the more controversial patients of my GP’s on the bus that I was catching to get to the community psychiatric centre. She’d been involved in a fairly large scandal that had gotten some amount of media attention involving a child. There was a court case — worse, I had been seeing her that other week in lieu of her GP, and knew all the details intimately. Luckily, I was wearing my glasses that day (I usually wear contacts to the GP, and am apparently almost unrecognisable to those who don’t know me well when switching between the two. The few times I wore glasses there nobody recognised me, and it was embarrassing for all parties involved).
That aside, it was an uneventful day. I got there after the doctor had come back from lunch (the same place, ordering the same meal everyday) and the clinic was busy in the afternoon. Clozapine clinic generally isn’t fun for me, except the in-between times when Dr. Ojo quizzes me on parts of psychiatry and the DSM, or get caught in a debate about ethics, personal development or what we’d like to be delusional about (grandiose delusions, for sure).
My lips went down toward late afternoon, much to my relief.
I don’t think it was an allergy. >50% of these things are idiopathic anyway. Booyeah. =) (I had a patient like this last year, and in early February).
Just when I thought I’d recovered, I got sick again. This time, with coloured nasal discharge — sure sign of some immune battle going on where the previous times had been less sinister sounding.
This Tuesday has been tainted by a constantly running nose - I weighed myself, and I’ve lost 2-3kg since last week around this time. The lowered immunity, I hoped, has nothing to do with a global disturbance in my system.
Yesterday I’d done a second minor surgical procedure by myself — cutting a lesion out of someone’s arm and sewing it back together unsupervised — but managed to scratch myself with the tip of the scalpel while scraping off someone’s keratosis afterwards. I felt really stupid; and then I started to feel paranoid. Surely a 50-something year old farmer with a decent family life wouldn’t be positive for any blood-bourne disease, right? Surely when I asked him he wouldn’t have lied, right?
In the end I semi-jokingly asked if he could do a blood test for me. And then when he semi-jokingly said he wouldn’t mind, I gave him a blood slip for Thursday.
The actual place where I poked myself is smaller than a paper cut. it barely even went through skin — and the place had disappeared within 2 hours anyway. It was through gloves, and there was only minor trace of blood on the scalpel (I hadn’t been using the tip when scraping). I stare at the tinly tiny thing with so much resentment. It’s hard to imagine that this spot could ruin my life (though I doubt it very much in this case).
In junior school, people didn’t really take needlesticks seriously. I was teaching suturing at the medical school organised clinical weekend for the first and second years, and the general attitude was ‘oh well’. Oh well, we all imagine it won’t happen. Just a spot of blood —
Chuan Tai and I were discussing this the other day. He’s doing Obstetrics, and he was saying that the post-partum haemorrhages in women were astounding. This woman just bled like a gutted pig for ages after giving birth. It was all over his shirt, all over his shoes and pants. All over his glasses and mask. If she had been anything-positive, it could have ended his medical career.
"I saw my life flash before my eyes, Mel."
Today also was/is special. It’s meant to be dinner night with the psychiatrists at the community health centre. I’d harrassed them into inviting Renny and Tshenolo enough over the month because I felt awkward going by myself, and also I wanted to include Renny in things because we lived together.
Ok~ talking about routine… the thing is, Dr. Ojo had been eating at the same place and ordering the same thing every lunch time for however many years. I’ve teased him about it all semester, and then ordered different things every week to satisfy my own curiosity. In fact the dinner tonight was originally supposed to be at the same family-owned restaurant that makes incredibly large servings and not-that-great food.
Imagine my surprise when I discover that not only had he suddenly changed his mind about dinner tonight —- Nielson’s restuarant (in the Age Good Food Guide, no less!) — but that lunch time he declared that he was going to change his routine and asked me if there was some place I wanted to eat.
Suddenly, a random feeling of anxiety came over me. Weird — I had slowly come to the expectation that we’d be doing something at sometime every Tuesday, even though I rebelled against it. Going somewhere new suddenly broke that expectation, and made me feel nervous. So this is why people stick to routines! It’s safe, it’s reliable — and very hard to break even when you get into it subconsciously, or even unwillingly.
Still, I felt a feeling of success as we parked at some other place. All my harrassment had paid off — this was big. This was bigger than big; this was huge. When I told Dr. Ojo, he laughed.
Despite the horrific sensation of my brain being pulled out of my nose all day (it’s not pleasant), I was happy. :)
So here I am, waiting at the hospital for Renny to come by so I can give her directions to the restaurant.
On the way to the commonroom, I came across Julie (who recognised me by the way I continually sneezed down the corridor without having seen me). She told me not to go, the handed me an envelope — it looked like a card — and said it was for giving my time to teaching suturing last Saturday. I told her it was sweet, and continued.. except it struck me that the envelope was oddly heavy for a card. Maybe it was a cute applique kind of card that had bits stuck on it?
I opened it, and there was a multipurpose gift card for all the major food, stationary and department stores on it.
We all build castles. Sometimes they’re made of sand — They fall down, be we keep trying to pull them up.
Even when it’s insane. Even when it seems like we should move further inland — use rocks instead. Use mud and mortar~
It’s not that we’re stupid. We know the universal laws, and still we choose to battle on at the seafront. We can see the waves that come; we can see the safety of the highlands, and still we build that house of sand, that house of driftwood and foam that disappears from our fingers.
That’s the thing about choice, I suppose.
It might not on the surface be the smart move — but it doesn’t mean that it was chosen lightly, or the person didn’t know what the better options were.
Sometimes you feel frustrated at yourself for not being the person who could leave it alone.
You think I am judging you. I’m not judging you.
I’m in a doctor’s chair; I’m printing your scripts, looking at your bruises and telling you what salve to use; I’m saying, leave him because it’s my job to say the right things to you — but I’m touching your arm. You say I look young and undamaged but..
Chuan Tai:Actually, I think of what Dr. Narayan said in the past about his friend in some US hospital who knew a lot of stuff but didn't get recognition or something, until the day he diagnosed a collapsed person with dissection in the corridor and saved his life.
Chuan Tai:You remember the story, Mel?
Melissa:Oh yes. The corridor diagnosis story.
Chuan Tai:Sometmes when I walk the corridors of the hospital, my mind is always going what I will do if someone collapses in front of me. Then I think of what Dr. Narayan says and start smiling...
Chuan Tai:And sometimes some of the visitors and patients will smile back at me as if I'm smiling at them.
Saturday: a horrible day spent in and out of clear consciousness. Just when I thought I was ready to suffer a week of nasty cold virus (the one that pretty much KOed Renny last week), I woke up Sunday morning and was pretty much cured!
My letters will have shown you how lovely I am. I don’t dine at Court, I see few people, and take my walks alone, and at every beautiful spot I wish you were there.
I can’t help loving you more than is good for me; I shall feel all the happier when I see you again. I am always conscious of my nearness to you, your presence never leaves me. In you I have a measure for every woman, for everyone; in your love a measure for all that is to be. Not in the sense that the rest of the world seems obscure tome, on the contrary, your love makes it clear; I see quite clearly what men are like and what they plan, wish, do and enjoy; I don’t grudge them what they have, and comparing is a secret joy to me, possessing as I do such an imperishable treasure.
You in your household must feel as I often do in my affairs; we often don’t notice objects simply because we don’t choose to look at them, but things acquire an interest as soon as we see clearly the way they are related to each other. For we always like to join in, and the good man takes pleasure in arranging, putting in order and furthering the right and its peaceful rule.
Adieu, you whom I love a thousand times.
-Johann Wolfgang von Goethe, ‘Letter to Charlotte von Stein’
Maybe it’s because it’s late at night, or because I am tired — I have been thinking too much again.
At the crux of this are my Tuesdays: Tuesdays are an alien day of the week during which I seem to, by some miracle of physics, have an abundance of time at the community mental health centre. Clozapine Clinic doesn’t start until 11am, and is the most mundane thing in the world — just an endless list of people who need to be monitored for side effects and early warning signs via survey and casual chat about their lives.
The morning starts off with a long, solitary bus ride half asleep through Newborough and Morwell and then back on the freeway to Traralgon. I usually unfog the glass and watch people getting on or off — some know the driver by name. Other times, Julie comes to pick me up on her way to work and drops me off at the bus stop outside the hospital in Traralgon, which makes no difference except that I have time for coffee before boarding the same bus that would have left at 8am outside my house if Julie hadn’t come anyway.
I get along fairly well with my psychiatrist. He doesn’t seem to mind my comings and goings around the office. Sometimes I chase the files of patients who’ve just seen on the ward, an who’ve been recently discharged. As a medical student, I have the rare privilege of working with the team treating the patient both in the inpatient and outpatient setting. Other times, I wander into the kitchen and take a very long time making myself hot chocolate.
Recently, I’ve been having strangely involved conversations with this psychiatrist.
Usually Dr. Ojo works on some paperwork in the morning after intake meeting, or runs postal errands while I hack another psychiatrist’s computer to look up journal articles and catch up on reading. I’m constantly late for intake meeting because the first bus only gets there at ten to nine, and usually arrive trying to untangle a scarf and jacket with grass all over my shoes from trecking through a lawn the size of a field (I really shouldn’t short cut like that, but there appears to be no sign warning me otherwise).
At lunch he drives us to a Vietnamese place in town where he goes everyday and orders the same thing for lunch — despite an extensive menu. I usually try and convince him to order something else (as if I could revoke years of habit), and then order extravagantly different things out of curiosity. He then eats industrially while I try to catch up, and pays for everything (to claim work related tax deduction, probably).
The ride back is a variable journey, depending on agenda. Once he took me on a mysterious ride around Traralgon looking for an address — once we arrived at the address, he drove past it slowly like he was a stalker, then drove off again. He then admitted when I pressed him that handed his child to a different nanny not known to him that morning, and was checking out her address. (A cute display of anxiety — when I told him that it was touching that he was worried about his child he replied that defensively that he wasn’t as he’d talked to her that day, and heard his child still alive in the background).
Last Tuesday we somehow got onto the topic of motivation in one of our inane conversations. It had evolved from a debate about the role of women in the pain and suffering of men from an Adam and Eve debate. I argued that if Adam weren’t highly suggestible and if the relationship weren’t an unhealthy one where Adam’s wishes were not heard in the couple, then none of this would have happened.
The week before that, I had admitted that I was fairly upset at the idea of having a little brother when I was 12, and how hurt I was that my parents hadn’t thought to discuss it with me first. And how looking back at that point, my parents had every right not to discuss it with me first, but that they had actually promised before, and it was more the broken promise that hurt.
It’s not fair that psychiatry makes you look at yourself in such a harsh, critical way — how close you are to madness. I hate how I picked a manic patient without knowing the psychodynamics behind it first. Formulating her case, I felt more and more drawn into the fact that we are not dissimilar psychodynamically in some ways; yet she is manic, and I am sane. I think of Ophelia’s madness and it’s protective ways. We learnt to see her as fragile in studying the play — just a woman who broke when things got tough. But why should we, the privileged, discriminate against breaking if we ourselves haven’t been through the same force? When I was in Child Psychiatry, a young girl (still in her mid-teens) went ‘mad’ a few months ago. She’d been gang raped by her father and impregnated by her grandfather and placed in foster care. During the bushfires, her foster family house was burnt and they went to stay in a motel — she then tried to kill herself because it happened that the motel they stayed at was the motel that she got gang-raped at.
What kind of ‘coping mechanisms’ and ‘mature defenses’ could possibly exist to handle that kind of injury? How is madness not the answer in that case?
Talk about inescapable fate: people genetically predisposed to mental illness have a higher incidence of adverse, stressful or traumatic events happening to them in their lifetime compared to a person without genetic predisposition.
In talking to Dr. Ojo last Tuesday, we ended up going over motivation. I think I started it — I was wondering out loud at how I had been thinking about a situation that happened a year or so back when I had been really tired trying to walk to somewhere, and someone mentioned kindly that I should just pretend that I was nearly at the goal to make the journey easier. This seemed really strange to me as in reality, I actually did the opposite during middle and high school walking home from the bus stop after a long, exhausting day and trying not to fall asleep on the bus. I always picture the destination as a lot further than it actually is so that I am mentally overprepared, and always surprised when I get there sooner than I’d anticipated.
To me, the other person’s suggestion seemed to set itself up for constant disappointment.
I asked him what would motivate him in that scenario. He said nothing, except an aim to achieve the goal (the destination). He had an “it just has to be done” scenario. When I asked him if he had any strategies other than grim inevitability and destination-orientation that made it easier and he said no. I was immediately reminded of most of my other friends — particularly the more career orientated ones.
I must have seemed surprised, because he explained that for him, there was no other means of fulfilment in life than achieving a goal. There are very little things that cause happiness other than bearing fruit a plan to attain something that had been set in motion prior to the task.
"I seem to stumble on fulfilment a little more sporadically," I said. He asked me to explain; so I told him for example that I was happy that day, compared to the previous day — or at least, more fulfilled than the day before. When he asked me what made it so, I said that the day before had lots of boring lectures and stressful task-orientated activities.
"But what is so different from this day and the last?" he asked. "Did anything happen today?"—- I replied in the negative —- "Ah. So in fact, today is no more different than yesterday. It’s just your perception of two continuous days that has changed."
I thought about this. I was definitely happier today than yesterday — but why? What made it substantially different from his two-days-in-a-row? It suddenly occurred to me: I liked Tuesdays because I had more freedom, and less pressure. I enjoyed his company.
"I suppose I find fulfilment when my needs are met," I said.
"What kind of needs?"
I explained what I liked about Tuesdays: food, friendly colleagues, good conversation, seeing patients, a sense of freedom, a sense of learning something. All of these things made me happy.
He seemed to consider.
"I’ve always been goal orientated," he explained. "I prefer it that way. I just want to get things done. But it makes me a little impersonal."
"I end up just doing things as a means to achieve the end. Each day is similar to the next one — there are no fluctuations in my mood. I am similar each day. But I become inhuman. I don’t take time to live life — To feel pain when something painful happens, or find joy when something good happens on a day to day basis. I miss out on the experience of being alive."
I thought about it. “It wouldn’t be a bad thing, to not feel pain.”
It’s strange. Sometimes I feel unstable compared to other, more steady less reactive friends —
It wasn’t saying that I was unhappy; nor was I eruptive, emotional or manic. Rather, I felt that my happiness was constantly evolving with the things I came across, like a landscape passing outside the car — the immediate landscape moving faster than points on the horizon.
I don’t think the majority of people I know are impersonal or inhuman in particular. There are extremes as with any sample…but I cannot use them to generalise. Sometimes due to life events, they become one extreme or the polar opposite from what they were before —I’ve seen this in two different people.
In a lot of ways, I’m still envious of goal orientated people. I have things I want to achieve in life, and a direction — but isn’t the be-all and end-all. And even so, for all intensive purposes according to the Dr. Lampel and various surgical and medical registrars/consultants last year (Dr. Ariathianto, Dr. Campbell, etc.) — I have the appearance and manner of a fairly driven young person in my approach to people and situations.
I think the mistake that I tend to make (whether or not this is actually a mistake) is to assume that people who are soley goal driven are unhappy. Likewise, I think I can appear to goal orientated people as someone who is a little lost and directionless. Possibly a little clueless with haphazard response to stimuli.
What if neither of us were what we thought we were?
I suppose the trouble lies if one of those types of people convinces themselves they’re in fact the other…
Regardless…in my medical entrance interview I was asked about what I thought the definition of success was. I’d answered, after some thought, that it was achieving a balance in life. I still think this is the case (which is probably why I feel career/goal orientated people are unhappy, rather than purely the fact they are career/goal orientated).
The older you get, the harder it is to find balance — especially if starting from scratch. It makes it easy if you’ve had history in some place — easier to feel content, happy. Conversely, it makes it hard to leave somewhere even if that place (physical or metaphorical) is no longer what you want or need.
I am happy I am in Melbourne now. It’s such a different place. I miss having close friends close by and being around them or laughing at shared memories and injokes. I miss the opportunity of never being alone for a long period of time, and the safety of pre-existing love. But..after the first break — I feel free. I have no ties. I am light — I can have adventures, go overseas. My elective is coming up next year (concurrent with a holiday rotation in the middle of the year) — I need to start thinking about where I want to be. Local? Overseas? London? Third world country?
Saturday morning, Leo and I cut down the tree in the back yard. Or rather, he stood on the red ladder sawing at its branches while I watched beside the porch in Alex’s oversized grey sweater (which I love!).
There must be a version of the perfect yard, the perfect house somewhere, and this house was it. A comfortable, homely place with a large yard and a Victorian playhouse and sandpit left from previous owners. The door had broken off its hinge, and Jing had gone to the hardward shop to buy a new one that morning.
Japanese maples stood at the perimeter of the grass, near the house forming branched archways near where the paving ended. Leaves they had shed covered the ground beneath like second skin. Bees were hard at work along the hibiscus plant (causing Leo some fear) and ants were forming strange scattered lines a the edge of the studio shed.
Everything was crisp, clean.
I couldn’t picture a better house for myself than this, someday. I fell in love with it three years ago, the moment I stepped in the doorway (still so young and distracted then).
How is it that sunlight in winter seems whiter somehow?
Jonny and I went out for coffee and cake after lunch. He was down from Ballarat this weekend, training instead of flying back with an aircraft pickup because of an emergency that needed attending to on Friday (airplanes stranded due to bad weather conditions).
I told him he worked way too much, though I knew he knew it too. I wish he’d look after himself more; I wish that he had something he valued more than work, or a place in the world other than on the corporate ladder. He told me about buying a house recently, at 22. His face when I congratulated him said it all. This was an empty achievement - something to do, because he could/his mother suggested it — an investment property he’ll never live in, or decorate, or make a home.
I want to be excited when I buy my first house. I want to celebrate that milestone.
It’s strange seeing him with Alex gone.
I had just been thinking these past few weeks of how much I missed Alex. The jumper he gave me is my favourite for nostalgic reasons (an old one of his that I’d asked for one day when going through his closet one day).
I don’t think I appreciated how hard it was to be that comfortable around someone. I miss taking his bedroom for granted. I used to walk in with a book and flop down on his bed; he’d hand me a can of whatever kind of drink he’d bought from the asian groceries he sometimes worked at wordlessly or hand me the packet of whatever he was eating. I miss having company while I studied, and the sound of him playing the computer games; or getting his fortune telling charm in the form of a minature iced-tea toy that spat sticks of different colours out depicting “yes”, “no”, “proceed with caution” or “maybe” (the actual writing on these sticks was in Japanese, so I just listened to whatever Alex said) and shaking it until I got the answers I wanted.
"What are you so desperately asking it?" he wondered once. Everytime I went to his room, it was routine. I’d usually come up with a silly answer, like whether his future wife will have a pox-marked face.
In a world of complex relationships, it was just a relief to have a simple, carefree one.
And even though he says he’s fine, I wonder if he’ll ever get over his ex-girlfriend.
This morning I talked to him for the first time since he left. It was a coinicidental meeting online, and he’s doing well. It surprised me he was in Shanghai, having finally met his online girlfriend of the last few months before he’d left. He told me he met Yulie too, another flatmate of mine who’d moved to Sydney a long time ago. Strange, I haven’t thought of her in a long time.
And he’s working for Spring Airlines, so the letter I translated for him must have paid off. I’m happy: he’s finally being able to live his dream as a commercial pilot.
I feel nostalgic. In hindsight, I am pretty lucky.