My alarm went off at 8, but I woke to what looked like 7. Autumn must have be coming. Mornings arive later, are less inviting. I was still pulling clothes on when I left the house, bobby pin in my mouth and a shoe in my hand, late for the medical therapy unit.
It turned out that the patient arrived over 2 hours later than me. We tried to kill time the best we could, moving old samples from the Pathology department to the Rheumatology labs in East block. We had coffee. We tried to read in the couches along the corridor.
An adorable little boy and his mother came and sat next to us. I fell in love with the way she offered him a choice between two bananas, ruffled his hair and peeled it for him. I’ve never seen two people more happier to do nothing but eat bananas together.
Sigh. I wanna be that kind of mum one day. The kind who asks a child to picking a banana out of two exact looking ones to let them know that they have autonomy in their lives, that they matter and are important. Everyday.
I was just thinking - there are so many expressions of love missed in the world. Everyone has their own things. Making sandwiches for another person, for example, to me, is so much an expression of a lifetime together. Or cutting apples for someone I love. Reading out loud. Making my father coffee or tea before I sleep when he’s pulling a late nighter. Listening to his philosophical ramblings and life stories like I’ve never heard them before, and knowing that he knew that I was doing that.
Or even a parent going to thalassemia clinic with his little girl. Contrary to popular belief, the med therapy unit is usually filled with patients in their 20s-40s. I’d stopped in the middle of my tracks in the hallway, balancing a file. A gorgeous 6-7 year old girl, blonde hair, olive skin, had trotted past, waving goodbye at the resident in the unit. A bandage was around her arm, and a line came through and wound up an IV pole she tugged at her side. Packed red cells. A bag of it.
Did she know what it was like to have a normal life? I doubted it. A bag of blood and a child didn’t seem to go together in any way.
Padma told me that once she saw a baby - a 6 month old, perhaps - sitting on a woman’s lap in clinic, hooked up to a bag. Not old enough to walk, but old enough for a stranger’s blood to be running through your veins — I suddenly understood why people couldn’t do Paediatric Haem/Onc (I was/am still considering. Adult haematology still appeals more - they get a more vast array of diseases).
With the deadline over (what an anticlimax that was), I took the afternoon off.
Sobering, really. I ate a lot of cantaloupe, slept a little. I was so inconsiderate and horrible last week — not that I did anything, but I wasn’t very thoughtful towards others…in my head. I’m still cringing at how mean I was about the cleaner thing…
There was a patient pick-up in the morning, followed by a mad attempt to add to my literature review (last minute as ever), then a trip to the Alfred for a meeting that was 30 minutes late, and 15 minutes in duration. The feedback today consisted of: “You should include some tables” and “I’ll see you next week. Let’s make this a weekly thing.”
That was it. Just that easy. It almost made no sense.
Wistful, I came back on the train. It had been a long day. Even centrifuging the blood hadn’t been straightforward - for some reason the heparin tube blood wouldn’t separate and took 20 minutes to spin into separate layers. 20 minutes! What was wrong with his cells? Were they super buoyant or something?
It’s really strange, the tiny little things that salvage your day from being completely crap. I kept bumping into the same person over and over - in the morning, picking up some files downstairs, later on in the stairwell, after a lecture, in the locker room, in the common room at the end of the day.. The more I bumped into him, the more amusing it got. Coincidences are kind of funny. And he always said hi, which was much appreciated.
Another Tuesday afternoon at the Alfred, the majority of which was spent kneeling on the floor of Professor R.’s office trying to dial through to the thalassemia consultant at MMC.
"I hear he’s notoriously hard to reach," he’d said. "Just get him on the phone and I’ll talk to him about withholding vitamin C. He never returns phone calls."
So surprised was I to get through to him on the first go that I nearly dropped the phone. This seemingly miraculous phone propensity continued work in my favour when trying to get a clinical pharmacologist on the phone, one who was used to working with plate readers and photospectroscopy (we’d tried 6 machines and none of them were getting us anywhere).
Luck ended there, however. “Melissa, did we say we’d meet about the literature review today? Let’s make it tomorrow. By the way, can you write up a bit on other causes of cardiac dysfunction for me, other than iron overload?”
Padma and I went and had dinner in the city to commiserate. She had her faculty presentation the next day, and I had seemingly more paperwork ahead (the original plan had been to sleep early). Durian ice cream cheered me up considerably - not that I am a huge durian fan, but it brought back memories of a high school friend who went crazy every time the word was even mentioned.
When I got home I discovered the dog had shredded a couch cushion, necessitating immediate removal of myself from the premises (definitely did not want to be there when my flatmate came home to find the mess).
Got changed into comfortable clothing and went to MMC for a couple of hours work.
The cleaner came in. He began telling me about reflux symptoms and what sounded like waterbrash in the morning. I started getting really uncomfortable. He told me he was waiting from a gastroscopy, and made dramatic eyes at me — “They even took blood from me,” he said.
I smiled. Have you ever noticed that when people want to emphasise the gravity of their undiagnosed illness, they tell you that doctors took some blood? Blood tests are a huge deal.
I guess in medical school we kinda don’t realise that. We jab people/get jabbed way too often. For example, the other week Padma approached me with a needle and said, “Hey, gimme some blood, I need to re-calibrate the machine”. I was in the middle of doing something, so we put a paper towel on the table in case we made a mess, tied gloves together to make a tournequet, and bam! I was bled like a pig, then carried on with my work.
The cleaner looked really concerned, so I tried to be reassuring. It was hard - mostly because we were speaking in Chinese and I had no clue as to what investigation he was talking about (my Chinese doesn’t branch out to medical terminology). It could have been gastroscopy, but in hindsight it could just as likely have been bronchoscopy, induced sputum, or chest Xray - did he mention blood streaked sputum? I said that they were probably just running some tests to look for things that might be causing it. Just because it might be an invasive test doesn’t mean they think he has cancer or anything.
Then he said, “Give me your phone number. When my gastroscopy comes back or if I ever have any concerns about anything medical at any time, I will give you a call and ask you all about it.”
I hate being Chinese sometimes. There’s this networking ethos floating around somewhere, which my family has never bought into. There are some people - mostly from old school families - who always try and mobilise other people around them for personal gain.
I remember a client of my dad’s who had come to our house to present some documents to be translated. He’d bought his whole family with him, walked in and told my father that his daughter was gorgeous and please, please, please review his case at a ridiculous 10% of usual fee. Please.
My father had clearly been reluctant. It was a lot of work, and not an easy case either. Besides, he had a day job - he’d have to find time to do it in his capacity as a qualified immigration document translator.
Then the man held his wife’s hand, and touched the head of one of his children (who were busy playing with our stuff). We are poor, we can hardly eat, he said. We are trying so hard to make ends meet.
Yeah you’re so poor and hard doneby, you almost have to sell your brand new BMW that you drove your family here in was what I wanted to say to the man in our sitting room. Being 16, it probably wasn’t a good idea to barge in like that.
Everyone knew my dad would make the worst businessman in the world. He ended up giving them the thing at 10%. For that matter, I would probably have done it too, being just as easily manipulated. Knowing that about me just made me more angry on my father’s behalf.
GRR, old-school Asian cleaner!
I told him that I wasn’t a doctor, and that the doctors at MMC were all A-grade.
He thanked me and said, “When you get old, you get really scared, you know?”
Suddenly I felt guilty. It would be scary, having things go wrong with you. He was an aging man. It’s scary and lonely and horrible and I was coming from a place of privilege of being young and educated and healthy.
Ugh. Lack of sleep is turning me into a horrible person.
Writing the perfect literature review, and why I never became an artist
When I was a little girl, I wondered why things inside my head never could translate perfectly outside it when it came to creating things.
I tried to draw a clown once. I was really determined - I could picture every hair on his head, the shading, the texture of skin and pores blocked by a layer of paint, where to shade shadows, the direction of light…almost like a photograph. So convinced that I could put it down on paper, I went and got a pencil and some paper. I imagined myself drawing the clown, and the angles my pencil had to move to get all the details and tried to follow the same movements with my hand.
Mum went by and was like, wow, that’s a nice looking bear/elephant!
13 years on, nothing has changed.
I spent almost all of last week reading for my literature review. I knew exactly what I’m going to say (to the point of having headings and subheadings all structuredo out) and exactly where to reference things (which papers said what fact, on which page), and what the argument comes where and which articles are valid (I skim read all the methods sections) and what the critique is…
Except sitting down and writing it out is actually killing me.
Ugh. I hate reality.
Watching people leave the common room this afternoon I almost started subconsciously adding ‘take me with youuuuu’ every time they left.
At least I’m nearly done. :) I guess all the hard work did pay off in the end. When this is over, I am going to be taking so many days off it’s not even funny.
If you have 2 copies of the CCR5Δ32gene polymorphism, you are immune to most strains of HIV.
Most types of HIV virus uses a CCR5 co-receptor to enter T-cells when infecting the host. In people homozygous for CCR5Δ32, this co-receptor is non-functional, making viruses are unable to enter host cells.
CCR5Δ32 alleles have the highest prevalence in Northern Europeans (around 10%). Scientists trace this back to the plague and smallpox, which mixed up the gene pool and allowed CCR5Δ32alleles to be more prominent.
Although they can still be infected by HIV viruses using CXCR4 co-receptor instead of CCR5 to enter cells (termed ‘syncitial inducing viruses’), these people also show a decreased number of CXCR4 surface molecules and have better prognosis than others who catch that form of the virus.
Even one copy of CCR5Δ32 prevents AIDS progression by up to 2 years.
A friend and I drove out to Carrum at 1am on Friday night. The Napean highway was empty - not even a single car in sight. Strange, last December was the first time I’d ever been down it, despite needing to go to Frankston everyday for all of 8 weeks. I’d always thought that a highway would wide and multi-laned, but driving down the Napean is always like driving down any other road.
Getting down to the beach was eerie. It was so silent, and the place we parked looked so dodgy. There was even a hummer parked down from us with nobody inside and abandoned looking buildings with signs that said things like ‘boat house’. Somewhere, a dog barked. I kept asking my friend if he was there to kill me, store my body in some bin somewhere (and if so could he please refrain?).
(“For fuck’s sake, woman, you’ve known me for years” — “Yeah but, people are always getting slaughtered by someone they know.”)
Suddenly, the pathway gave way to a giant nothingness, and a distinctive roar There it was, laid out before us - the sea.
I grew up on an isthmus of an island (literally! North Island). Bonfires, marshmallows, family outings, falling in love — the sea was was always in the background. Without it, I feel claustrophobic, unhappy - something I had to get used to when I first moved here (such a minor detail to miss, really).
From Carrum you could see, if you wheeled round to look at the land, the lights from the penninsula in one direction and almost the skyscrapers of the city in the other. At night, you always think there’d be something in the distance, but there isn’t. There’s no light, just pitch black. The only way you know where the horizon is is that there’s a denser darkness to the water than the sky.
And the stars! I had spent a lot of time at the observatory near my house in primary school. I could name the formations, still.
It turned out that Brian had dragged me out there for some relationship advice. God it’s so silly, everyone seems to be tracking the same way. Was it Paeds or Obgyn that changed us?
All I could really tell him was not to be one of those people who either 1) didn’t know how to show love or 2) didn’t know how to recognise love when he saw it. That, and that girls aren’t that hard to figure out. Just don’t be an asshole. (Specific, I know).
When I did get home, 3am with sand in my hair, I found that my douchebag flatmate had returned from China. Judging from the beer belch and the 6L worth of empty bottles on the couch, I’d say he’d been back for some time.
Me: “AHHHTHEFUC— Surprised! Yes I am. I am surprised.
Him: “Did you miss me?”
Me: “I gotta…I gotta go to my room.”
Him: “Do you think I’ve gained weight..?”
If I didn’t think I was spending enough time away from home, you can bet that time is gonna increase 10 fold now. Helllooooo MMC common room. Can’t wait until it’s no longer convenient to live here.
A friend called a few days ago, wanting to debrief about a patient of his who died of a massive infarct.
While listening to him, I got thinking: people always ask if it’s difficult working with already dead people when they find out you’re in medical school (cadavers). Nobody ever asks you what it’s like working with living people who die on you.
Why is that, exactly?
When I was on Haematology in third year, a man came in for treatment of a relapsed AML. As a medical student my job was to shake the blood tubes in bone marrow aspiration/trepines and make sure that patients, partially sedated with midazolam, didn’t do anything silly. Though often quoted as making people ‘feel a little bit drunk’, midazolam - when it doesn’t knock people out - can on occassion also make them act like it. In this man’s case, he became a giggling 5 year old that I was constantly telling off. (“NO MR. G DON’T ROLL OVER, IT’S NOT FUNNY!”)
He developed febrile neutropenia about a week in. We put him on antibiotics, maintained his fluids (I put my first large bore IV in - it was horrible. You can actually feel the vein pop if you’ve accidentally gone through the other end)
One day on ward round, Professor S took the man’s 2 sons aside while he was asleep.
"He can’t go on like this," he said. He talked about dignity. This man could probably recover from this AML episode if we treated him, but who knew how long that would take. Who knew when he would relapse again. I remember being shocked. The man had seemed ok to me. Sure he lapsed out of consciousness now and then, but who didn’t while on hardcore chemo, right?
Professor S proposed withdrawal of treatment. “If it was my father, I would do that.”
The sons burst into tears in the corridor. We all stood with our heads down, watching grown men weep. They said they’d wait for their brother, before they decided. I was closest to the nursing station so I went to get tissues. More crying happened. They asked how long he’d last once they withdrew treatment (a few days). They asked for more time.
In a matter of hours and continuing on for days, dozens and dozens of people began to arrive, coming from all over the world. Someone was there day and night - you had to walk around dodging people crying to get anywhere in the ward. Family members got to know us by face, sometimes by name. Occassionally, one of them would bring food for the staff - a cake or something.
Then one day I turned up for ward round in the morning and everyone was gone. The door to the man’s room was open. The bed was empty. It was eerily quiet.
Even if we never talked about it, things had a way of finding its way through. A bed-bound delerious woman whom we were bone marrowing that day asked me about ‘that man down the corridor’, and whether he had died. “For days there was lots of people crying, and now they’re gone,” she said. “Tell me the truth, is he dead?”
What do you say to that? She also had AML. Her prognosis was probably about the same.
To make it worse, the patient who replaced the man who died in that room had exactly the same disease too. Most horrifically looked exactly like him. Build, hair, nose, mouth. They were from the same part of the world too.
It was creepy.
I rotated off soon after. I don’t know what happened to him.
I think everyone has a similar tale to tell. It goes: there was a man (or woman) under our team. He was diagnosed with x. We treated him with x. Once I had a two hour long convo with him about his kids/I held his hand while they did a procedure. We talked about his plans after discharge. I thought he would be fine. Then he arrested and died. It was so sudden.
And strangely, it always is sudden, even if you had seen it coming. And you for some reason, you always did think the patient would be fine, even though you knew how sick they are.
It’s 11pm, the end of a long but fairly good day. I like Wednesdays. You can see Friday floating in the distance, like some kind of beacon you should swim to.
I had to go back to campus for something yesterday.
Do you find that if you walk through a place you used to frequent a lot in the past, you go into a sort of time warp? Even though they’ve renovated everything on site, I still feel as if I had just come from 5 hours worth of lectures and everyone else I knew had gone home but I was still there for some reason. A weird, surreal feeling.
At the bank was a woman I distinctly remember from first year. Blonde with full bone structure, she’d always reminded me of an actress off CSI Miami (not the main character, just one of the team). She’d always end each visit with a pre-rehearsed speech about rating her performance from 0 to 10. Once, she weighed about 60 dollars worth of loose change for me.
I think people who stay at their job for years on end are fascinating. I can’t imagine working at a job where everyday is essentially the same (I guess my parents do it all the time).
When I got home today I laughed. I’d fallen asleep at the library that afternoon and gotten panda eyes. Why did nobody tell me about this? I look emo every time…
Andy asked me how my deadline was going this afternoon and I had been a tad confused. Deadline? What deadline? — then I realised that I had been cramming articles in so much that I’d momentarily forgotten what I was doing it all for (I’d sort of put it out of my head that I didn’t just have to read all of these articles by next Tuesday, I had to write something about it too).
I’m so glad the day ended with him. He’s so easy to talk to, for some reason.
Tired but happy, I went home and straight to sleep — don’t think anybody in the world needed a nap at that point more than me.