The ward’s been busy these last few days - after a period of no consults, new ones keep popping up. Child with parafalcine empyema, child with candida meningitis; serious, brain things.
The news is constantly on in the background of the ward - a room, chatter amongst the nurses, a headline. Images in a patient’s room, turning away and tearing up watching images of Christchurch, the crushed cars and worse of all the silence of ruined buildings that ominously mean death. As the night winds down I read international news sites and scroll Al-Jazeera’s blog for news about Libya. There’s a photograph of a woman, a trail of blood down her face with her hands in a backhand victory sign - a silent show of resistance floating around the internet. There is graphic footage of burnt soldiers who refused to fire on civilians lying on the ground.
It’s been a long time since I’ve had to think of the Ring of Fire. To those unfamiliar, it’s a term given to the ring of techtonic plates that New Zealand sits on, causing it to experience on average at least one earthquake a day of 4.0 magnitude or more - largely unnoticed. We learnt about it in Year 9 science - watched videos of volcanoes erupting, learnt that death was imminent (the volcano beneath Lake Taupo is the most dangerous in the world, and eruption would put the world into another ice age).
Ring of Fire can describe so many things though. Images of bloodshed, people running in the streets, that tide that’s sweeping through the upper African continent…those burning posters, burning bodies -
It reminds me of the power of people, and the power of nature - two opposing forces, almost. As powerful as each other somehow, in creating death and nations - lands turned over by tides and volcanoes and ground-shaking fissures; Countries are built and burnt by the blood/sweat/tears of men and women.
It’s strange the instances when nationalism wells up inside oneself. A girl on Facebook posted the words to the New Zealand national anthem yesterday in response to the earthquake and suddenly it made me want to go home and help out with the efforts. There is a Maori verse to the anthem and it was that more than the English that seemed to give strength to the meaning behind what it was to be a country.
At times like these I’m glad that I will soon become a doctor. I’m glad that I will be someone useful - that my parents understood more than myself when I was 17 that human helplessness is one of the hardest things to bear. That in disaster I will be able to comfort, to heal.
I miss home.
We’re a simple people. We don’t understand things like death and unhappiness, and loss.
Maybe that’s why I hate those images the most. Because I’m not there, I’m not doing something with my hands. Small, insignificant things like handing someone a bottle of water, or washing out a wound, or even cataloging the dead.
Up on the ward, baby X holds on to life. The door to the room is closed every day, nobody goes inside, nobody goes outside. They are soon to go home and I’m thinking, about time. I want to die at home too, somewhere familiar and loved even if I’m too not-with-it to understand (old age). Perhaps baby X will understand too, somehow.
Looking at all our infants, holding their hands as Dr. B. examines them on ward rounds, tickling their faces with dummies, touching them for selfish reasons - a substitute to comforting someone.
When I’m with children, or people who I love, it makes me want to lay my life down for them so that they will never have to be thrown out into the world alone, never have to make a choice between hunger and exhaustion for survival, never feel profound loss, never meet the people who their parents should have warned them about.
So I want to go home. I want to be sad with other people in New Zealand instead of being sad in Australia, and guilty that I’m not doing anything other than donating money to Red Cross and watching pictures on TV, reading the news anxiously.
Thoughts and prayers are with those affected by the earthquake.
Do you ever find yourself doing something and think, when will this ever be useful to me in the future, ever? Tossing together a case presentation / literature review about Cryoprotein-associated periodic syndromes at the Yans’ house on Chinese New Years’ Eve felt a bit like that.
Maybe it was being stuffed full of duck, fish and chicken but I couldn’t sleep — the weather was cooling. Autumn was coming — a warm climate too soon over for my liking.
That night I had a nightmare about my old supervisor. I was conducting an experiment about people’s favourite colours. I marked on a sheet of paper every time someone gave an answer. “Blue and green” meant a mark next to both colours. When Prof R. saw my results he called me a liar, and that I must have made up the results because the total number of tallies didn’t match up to the total number of participants. Nothing I could say could reason with him about how I had come to have this mismatch. In the end I had to make up an excuse — tell him that I had tabulated the wrong sheet of paper/ miscalculated/made a mistake somewhere. I didn’t want to be called a liar. Also he was “never wrong”.
Now that the year is over I can say that honestly, I’ve never disliked someone professionally quite as much as that perhaps my entire life. Perhaps that prejudice extended to personal interactions too.
I owe everyone an apology.
When you feel you can’t trust someone, the sense of danger extends beyond working conditions. Worse is if you are dependent on them for something. Perhaps he felt the same about me. We were strangers, after all. On top of which, with his age-related memory lapses, inability to grasp tissue Doppler parameters after the sudden project change in June (which made up the basis of my experiment), or why I was stressed out about not having a control group. I suppose he was never a dependent though.
Sometimes I found myself wondering exactly how competent I was. I mean, I thought that all experiments needed proper control groups. Or that samples needed to be stored at -80C asap. However I’d get repeatedly slammed in meetings with this supervisor and my co-supervisor that I was being stupid.
The only saving grace is that whenever the subject was brought up with someone externally would talk about it they’d agree with my point of view invariably. Like the head of biochemistry at the hospital we were in, when we had a meeting the next day. The previous day, I had had a very polite but extensive argument about us really needed age and sex matched controls for a relatively new assay that Prof R. was very keen about. I had read the studies, and the manual (which, by the way, was a joke). We had nothing to compare it to, and the reference range was sourced in Italy where the population had many factors different to our population that could affect results. Age and gender and country of origin were very important.
"There are too many confounders. It’s well documented that age affects oxidative stress, for example. Old people have more oxidative stress."
"There is no evidence for old age being associated with increased oxidative stress." (Prof R. is supposed to be an expert at oxidative stress).
I didn’t know what to say. Surely age and oxidative stress is related. Surely. Even without quoting exact publications I knew it had been at the background of things I’d previously read.
"For God’s sake, we don’t need matched controls," he repeated, frustratedly. I knew I was being rude/disrespectful. "As if every time the GP looks at your blood test results he compares it to data for people of your exact age. All he needs is a laboratory reference range. Like we can use."
"I don’t know…haemoglobin reference ranges, for instance, are different for different age groups. Neonates for example. And also different for male and female. Your results are compared to people in the same group as you…"
"You just don’t need age and sex matched controls, Melissa." he snapped.
My other supervisor said, “Are you done having a break down now?”
The next day in a meeting with the head of Biochem, this topic got brought up. Prof R. asked if we needed age and sex matched controls by saying, “We don’t need age and sex matched controls and all this nonsense do we? I mean, a reference range would do, given that it’s a lab test.”
"Actually since it’s so new and unvalidated, you probably should."
"Yes," Prof R. said. "That’ right. We should. That’s what I said too. I mean, it’s well documented that oxidative stress increases with age, which could confound things if using a broad reference range. I guess even haemoglobin reference ranges are grouped by age and sex, aren’t they."
I wanted to laugh and cry at the same time.
We never did age or sex match either. I never brought it up again.
This story is just one of many that throughout the year, made me wonder if I should quit Medicine altogether. I questioned everything, because Prof R constantly insisted that my thinking was wrong in some way. Things that I took for granted. Once he asked me what ‘secondary iron overload’ meant because he didn’t understand the word ‘secondary’ in a clinical context. It was in a presentation — and he insisted that I replace it with another word because if he could not understand the term, then nobody could.
Which medical person (other than first year medical students) didn’t understand the term ‘secondary’?
So of course, him being a professor, and me being a simple student, I started wondering if I were using the word secondary correctly. Which was absurd.
I’d draw word blanks in the middle of the day. When somebody would ask me a question I’d panic and forget things.
I seriously considered changing careers because I felt like this whole industry was a farce if people like him were at the heads of units. It made me feel that everything was unfair, and that people up the top weren’t really there because they were any good but because they were old and had lots of influence. There is no internal policing.
When my father heard what was happening (having the supreme bad luck of calling at precisely that moment), he told me to quit the course.
"I’ve done a Ph.D", Dad said, "and I know what supervisors are like. And this man sounds terrible."
That was the time when 2 hours before the deadline, my supervisor called to tell me that he refused to let me hand in my thesis because he couldn’t be a part of something so poorly written.
Changing very little, but after many phone calls in which I had to explain scientific terms and if they were good for prognosis or bad because he didn’t understand tissue Doppler after 6 months of having a student talk about it constantly, and after he took the time to actually think about it properly and to summarise my own work back at me like all of the conclusions were his idea, he called to say “Actually it’s quite good.”
When I received my grade (high distinction as I had expected, and as he had undoubtedly had an aneurysm over because I swear he thought I would fail), I dutifully wrote him a polite thank you card and promptly skipped the country to recover from the worst year of my life.
There you have it.
I wish it were the end. But I still have all the data and I still am working on collecting it and I used to think that it’s the most wasteful thing I’ve done in a long time.
But I refuse to let down all the pleasant people I did meet during my year, like the other people in my lab and the staff of the cardiac department here — all the nurses in the Thal’ clinic and those lovely cups of tea. :)
They say nothing is a waste in that respect. I tend to agree.
Steep learning curve aside, I never ever ever want to be made to feel the way I did last year ever again.
Thank you to the many, many friends who helped me stay afloat in one of the more difficult times.
Mixed blessings are still blessings. I’m a better person for it. <3 (The first class honours despite everything helped too )
Last night on a cover shift, in between my admissions, I found out we were going to palliate a child.
In the cubicle, I couldn’t concentrate. I just stared and stared at the piece of paper for a few seconds before I woke up from the daze.
This child (baby) had been with us a long time. We’d thought he was getting better until a few days ago and when I went to see him after a long period of not being involved in his care, I discovered someone fighting for their life. Or at least that’s what I’d thought privately, watching secretions occlude his little eyes, his mouth. Everywhere.
His mother was very kind. Someone who respected doctors. Who always says, “Whatever you think is best, Doc.” On Valentines Day, they’d given the staff a bunch of roses and chocolate and a note to say I’ll love you with all my heart, signed in the name of their baby boy (who had a heart defect amongst many other complicated things).
When I heard the news I was shocked. I kept thinking that if it was my own child, I would fight it. I would be filled with hate immediately, at the helplessness of the situation. I would begin to hate medical staff, the hospital, everything. How could you not save my child? How could you not do everything you could until the very end?
This I would do despite all my medical background, and despite knowing sometimes it’s more humane to palliate. Do no harm — the rule we all live by first and foremost.
Maybe in that way it proves that I’m not yet a mother. Because then I would love that child more than myself. And then I would know that it would be right to end their suffering, because I want them to be at peace more than I am afraid to be left alone, and to lose them. I’ve only loved someone that much once in my life. We were all very young then, with no reason not to. I may yet again.
Every day I see parents who give up so much of themselves for their children. Who feed them and change them when they have cerebal palsy, who mash and puree even when they’re 8 years old because they can’t talk or walk and smile or understand things other than pain and simple sensations.
There’s a saying — something about being redeemed when we love someone.
I always think about that when I see parents, because I wonder usually what life was like before the child came into their lives.
C. has moved on to become a Paediatrics consultant in Queensland. My new fellow is called K. I like her a lot. She wears comfortable clothes on the ward, and bright colours and spells her name in a eccentric way.
Once I asked K. about a neonate I had seen, who had been in care for a long time. It felt like we were harming her somehow. Or that’s how I felt every time I was in NICU, gazing at the swollen face — it is that baby who I had seen on my first day of Paeds — the one grossly swollen, intubated (the baby’s not changed much since then).
It felt like the right thing to do would be to do nothing. In this baby, more than the baby who is being palliated right now, who I thought deserved to be let go of more. >20 weeks of being comatose and tubed, and supported without much improvement..
"Are we harming this baby by keeping her alive?" I asked K one day. I think about this baby a lot.
Then I thought, it’s someone’s child. Of course you’d want to keep her alive. Of course you’d want him/her to go home - a place they have yet to know. I had seen the mother and father holding the child, stroking the oedematous cheek of the kid.
Babies in NICU often scare me, because of their fragility. They’re so easily comparable to a slab of butter at the supermarket - I’ve seen one weighing less than 500g. Imagine weighing as much as a block of butter. It’s heart breaking. At the same time the thought that they’ll live and become people that I might teach some day, or meet on the road some day is just amazing.
How did we come from so little to amount to so much?
I won’t write about the discussion K and I had, but she said that in neonatology these decisions were the hardest.
There’s a terrible satisfaction in Paediatrics, in knowing what to do - writing management plans on admissions and having them approved completely. The resident is often busy with the patients on the other team she is a part of so I do a lot of residents’ jobs.
It helps that the consultants are so nice. The other day we were all headed to a meeting and I had to dash back to the office to get some keys I’d left there. I came back into the long corridor halfway between the meeting room and the office just as Dr P.B. came down it and she asked me where I was going. When I got to the office, retrieved the key and eventually got back to the same corridor I saw the very bizarre sight her squatting on the floor against a wall in a sort of sitting position, reading through papers.
"What are you doing?" I’d blurted out.
"Waiting for you," she said, as if it was the most natural thing in the world.
Life drifts by so quickly. I never want to leave. Perhaps I will end up in Paediatrics after all. Give up on Haematology, fall in love with this culture of joy and stay forever. It’s not an unreal possibility.
Valentines Day came and went. I came home to find four hand picked roses and a box of chocolate with a rhyming note sitting outside my door signed Admirer. It took me a few seconds to realise that it was Will, to whom I’m like a sister, being really sweet, thanking me for all the life advice I’d offered him as a child growing up or something and listening to him talk about his relationship stuff.
Is it wrong for my first reaction to be irrational fear? Who the hell knew where I lived?! I’d moved recently. I thought it was from a complete stranger (best case scenario - but a little worrying), or some deranged stalker (worst case scenario).
But thank goodness, no. Just a lovely friend.
(I have such lovely friends!)
To all the people I love, I wish I could send you chocolate and flowers Valentines to thank you for all your advice and support over the years. Thanks for being so lovely. Hopefully you had a good day with the people who your Valentines should really be coming from (wink wink). And to other single people — meh, it’s just commercialism anyway ;p x