Day 1 on the bone marrow transplant: almost cried twice. My registrar before this one warned me that it would be sad, that he couldn’t do the job. I didn’t believe him because I didn’t know enough about bone marrow transplant, and because I’m young and optimistic.
To be fair, most patients recover, and can even be transplanted mostly as outpatients. When people are sick though, they are really sick. Sometimes they die.
The intensive care unit houses some of the most vulnerable patients. It’s beautiful, the ICU in the hospital I am at. In my first week, doing a consult for plasmaphoresis with my old unit, I admired the skylights that made the place seem perpetually happy. My registrar caught me and said, “It’s amazing isn’t it. This is the biggest ICU in Australia. The windows in the rooms? If they have to change a patient, they just flick a switch and it goes opaque.”
"Like on House!?"
"Just like House."
All my previous visits to ICU were for patients on other teams I’ve been with, who by and large were old and frail, and nearing their time. They’d never been my age before. They’d never been barely ten years older. They’d certainly never been younger.
I couldn’t do intensive care - I’m too scared, to be honest. I look at some of the people in my year who want to be intensivists and think to myself, you’re awfully bright but will you ever learn how to break bad news? Ask for organs? Perhaps I am still afraid of death, in my own way. There are so many people who are dying.
A woman lies in bed, bald. She’s just been transplanted but things aren’t going right - her blood’s been filtered because her kidneys aren’t great now, and she’s delirious because all the toxins are going to her brain. Sometimes she gets fevers. The registrar motions me outside the cubicle and says, “Transplant is one of the worst palliative methods in the world.”
It’s a joke - transplant is not a palliative method at all. He means, we transplanted her but she was going to die anyway.
So ask him why.
He said, “Without it, she had six months to live. She could have spent it at home. Transplant offered a small chance of cure, but the chance that if things went wrong like they were likely to do in her, she would spend the remaining six months she had in hospital, very unwell. If it were me, I would have chosen 6 good months. In the end it’s up to the patient. Everyone has personal reasons. You have to respect them. This woman has a very young child. She chose to be transplanted.”
Everyday we go in there, wake the woman up and try and talk to her. Some days she remembers where she is, or a name or a face. Other days, nothing at all. The registrar is cheerful, after each conversation. He asks her every day if she knows who he is. Her grunts sound the same to me but he says happily, “she’s more and more interactive every day.”
We are optimistic. It’s hard to tell how much time this will buy her, if any. I think of her young daughter, and the choice she made. When my mother was her age, I was just starting school. This could have been my mother. I hope her child realises the choice she made.
That’s not even the saddest story.
The bone marrow transplant registrar, M, who I will only know for a week, is probably one of the most important registrars I’ve met. He’s only on for one week and already I sense he’s taught me something that I will never forget in my entire life.
"They try and tell you to separate your emotions from your practise," he says. "But all of the good doctors I know do precisely the opposite of that. Don’t ever be afraid to feel things, as long as they don’t destroy you. I’ve sat in rooms with the families and patients and cried with them. "
Sometimes I wonder, is it better to know or not know your own fate? At times people say it’s not their place to say something. Having been a patient, it’s always your place to say something.
Don’t get me wrong, the majority of our patients make it out perfectly fine. I guess we’re having a bad run. This morning our entire team (which is usually very cheerful) made it up 7 floors in almost silence, and headed to make ourselves a cup of tea. The registrar stole us lollipops from the ward next door so we could cheer up.
On the tram back from the city to my car, I wondered if people really knew the kinds of heroic things that went on every day. Decisions like sacrificing your quality of life for your child. Knowingly facing death. People cling onto life. The kinds of winning and losing that people can’t even dream of.
“She waited for the train to pass. Then she said, “I sometimes think that people’s hearts are like deep wells. Nobody knows what’s at the bottom. All you can do is imagine by what comes floating to the surface every once in a while.”—from ‘Airplane’ — Haruki Murakami (via blacklies)
It took my little car all it had to get through the gale force wind and rain lashing at it mid-afternoon. I don’t know how the sky got from overcast to angry grey but the world changed, trying to erase all definable lines. It was hard to say where the road lanes were, where one street began and another ended. I kept hurtling forward, hoping I was in the right place, hoping I was heading the right direction.
It’s been a strange week and a bit - Between last Sunday and last Tuesday I’d already been wracked with fever, met my professional idol Prof S. the following day, and been a patient of an Emergency Department quite by accident because I for some reason almost collapsed on ward round a few days after that ever episode. While trying to get some anti-nausea tablets, I somehow found myself admitted own there.
It all started with Sunday, after work, walking back to the car in with the frigid winter wind around me and arms around my stomach to keep warm. The red scarf around my neck was doubling as a second layer, the way I pressed so hard trying to burn the fabric into me. As if force could provide heat somehow. Already then, I knew something was wrong - the world wasn’t in focus, like trying to catch things with great detail but missing all the intricacies that made them clear.
By the time I got home, I spent an entire hour staring out the window of my parked car shivering. The sun went down but I didn’t want to leave and walk the 10 metres into the house, too afraid of the cold.
It was only 7 o’clock when I made it inside but I went straight to bed, put the central heating on - everything hurt, my back especially. I was burning up. The sheets on my skin scorched me, and the irony only occurs to me now how the time I was pressing my scarf into me to turn force into warmth was coming true; except it was the opposite. Everything warm pressed into me. I was hallucinating. It lasted all night and didn’t break, though I was woken up several times by phone calls from my father and a friend - long conversations I can’t even remember.
By morning it had broken. Nothing else was wrong with me. I was exhausted, as if I had survived some kind of exorcism. Maybe I had. It wasn’t the first time these random fevers had happened to me.
I drove to meet Prof S. at 11:30am, so I cleaned myself up the best I could and drove to the institution that he was the head of.
Sometimes I don’t appreciate my luck the way I should: There I was. 23 years old, climbing out of bed and walking into the office of a man who had seen careers make and break, who was known to all the doctors in Melbourne, who had seen the rise and fall of many careers, I had looked up to since I was 20, who had recently been awarded the order of Australia; who I had seen talk to a family about withdrawing treatment from their dying father, who had changed the lives of so many before him and left an impression so deeply imprinted in my mind that I knew I wanted to be a haematologist right then. It was Queen’s Birthday - a public holiday - but he was in his office at the Australian Centre of Blood Diseases, wearing a jumper and in the most disarming way, was wearing the lanyard of the football team that I also supported.
"What have you done?" he asked me, like a father. I missed him, sudden. My own dad.
I told him I was following the haem/thrombosis registrar, and he said with surprise “You haven’t done Clinical Haematology yet?”
"No," I said. "But I did spend a long time in Haematology at X Hospital when I was in 3rd year. You were my consultant there for a week."
He smiled suddenly, as if delighted. “That’s right,” he said. “I remember you. I had been wondering where I’d seen you before, actually. Well. It’s good to see you again.”
Then he gave me the most inspiring talk, including about how I should aim to be the head of something, about mentorship, about what to do to be exceptional - about being exceptional, and what that means. About how everyone is exceptional, and only some people really exploit it. I couldn’t find a more amazing person in the world if I’d tried. It made me want to work harder, do more things. Be impressive.
So of course I was terribly embarrassed to be sitting on the ground on Tuesday with my head in my knees and the Haematology consultant (Harvard trained or a few years!) looking on in concern, and my registrar being ordered to get me some water. It was a mistake going through Emergency to get some medication - I’m at a hospital that’s known for being thorough. I should have known I wouldn’t be getting away that easily (it turned out to be nothing, like I knew it would be).
It was the first time I’d had a drip in my arm, and I now know to be nicer to people who are having them because they do actually hurt.
I’m sorry I haven’t written but it’s been such hectic time, running here and there to different hospitals for five or ten minutes’ worth of conversation. I had a rude shock when I returned to the ward after one of them: there I was in a suit jacket, shirt, black skirt with my ward folder (black leather) in hand (stethoscope folded on top), lanyard around my neck, ID, pen torch, ballpoint pen walking through the corridors of one of the oldest and most prestigious hospitals..in the second most livable city in the world. I looked in the glass that lined the corridor on the ground level, between two blocks of the building and saw someone I hardly recognised.
So strange, I hadn’t worn my hair this way for a while in hospital - fringe down but sides pinned back. Pins in my hair, until this year, had been a relatively primary school thing.
How was I so…grown up?
Even last night in Fitzroy, having drinks with a bunch of people I hardly see anymore (medical school kids from my old year, who had graduated and been working for half a year already), it was amazing the lives everyone led.
Going through the interview process for jobs, I’ve discovered two things: sometime in the last 6 years, I’ve developed an intense discomfort for situations of scrutiny. Interviews never bothered me before, and I was fairly ok at them — but now they make me intensely uncomfortable.
The second thing is, I’m definitely not the same person I was 6 years ago when going through all of these things (the interviews for entrance into medical school). What you learn about the world is shocking in 6 years. As a kid I used to wonder why adults were so worried about children changing — how can people not just go back to the way they used to be?
Now I know: once you know something, you can’t unknow it. Once you learn something, you can’t unlearn it.
I guess I’m trying to say that I miss simpler days, when nothing was too serious and I wasn’t suddenly on the verge of breaking into some incredible institutions of health. I certainly miss S., who is one of the people I will love all my life. I’m also saying, I’m grateful to be where I am, and to have such amazing people in my life like Been, Renny, Catrina, my family, all the doctors who’ve tried made me good at what I do. The shoulders of giants.
Being shortlisted for so many interviews when there are >850 candidates applying to some places and a few hundred interviews offered, I feel so lucky.
Whatever the outcome of my interviews, nothing is going to change the kind of doctor I am and will try to be.
“To love at all is to be vulnerable. Love anything, and your heart will certainly be wrung and possibly broken. If you want to make sure of keeping it intact, you must give your heart to no one, not even to an animal. Wrap it carefully round with hobbies and little luxuries; avoid all entanglements; lock it up safe in the casket or coffin of your selfishness. But in that casket - safe, dark, motionless, airless - it will change. It will not be broken; it will become unbreakable, impenetrable, irredeemable.”—C.S. Lewis (via mscrankypants)
The thing about living in a city that people like to visit is that inevitably, everyone who was ever anyone in your life drops by at some point. Neither the chilly wind of the Tasman gliding over the port in winter nor the melting heat in summer seems to stop them. There’s always a reason to be in Melbourne, if you want there to be.
Example: R.G., the primary school classmate from back in New Zealand I hadn’t seen for almost a decade. Imagine a conversation out of the blue with someone you weren’t that close with, but thought a lot of when you were ten years old.
There she was, brown coat, chocolate boots, turquoise scarf. Longer face, but the same mousy hair, sparce freckles, English looking nose. When I was little I thought she had the best hand writing in the world, the prettiest hair, and that she was good at everything. I’d memorise her signature, which was in cursive, and write it half unthinkingly over scraps of paper. She came to my birthday once. We went to the observatory because I had been going through an astronomy phase. We weren’t particularly close.
"I told my room-mate that I was worried I wouldn’t recognise you," she said. "It’s been, what, ten years?"
"Well you look exactly the same."
She didn’t say the same about me.
Stray memories kept popping up out of the blue, like when she talked about her younger sister. “When we were little, she used to want to be a investigatory journalist,” R. said. “And now she is the top of her business school at UNSW. And I’m the one going to the US and India and spending my time surfing at the beach.”
"Is your sister’s name Felicity?" I asked.
"Yes! How do you remember that?"
How did I remember that? I have no idea either - it seemed so long ago that I was ten. Like harbouring the memories of another person, almost — is this what it’s like to have an alternate life, or a past life remembered? All these facts that come out of nowhere, like when I pick up a violin and can play parts of pieces I used to know.
Before we left to go to drinks with some of her embryology friends up the river, she asked me to take her to the beach the next morning. Sadly I couldn’t. Unsaid was how much I wanted to go too. Maybe I will this weekend, if the weather is alright. If I finish my cover letters.
"I hope it’s not ten years before we see each other again," she said as she stepped off the tram.
How different we are now compared to who we were as kids. In your 20s, the distinction becomes a lot clearer than when you’re in your late teens.
It’s winter now, but it feels more like spring - bright sunlight, warmth in the air. The last few weeks before, there had been frost on my window every day of the morning but now it’s only fresh morning air on the glass. Sometimes I miss Aspendale, and tutoring there. Between trains, I’d wander down afterwards to the empty shore and trace the peninsula beneath my eyelashes.
Since leaving Surgery exactly one week ago, I’ve been thrust in the world of blood diseases. More specifically: bleeding and clotting disorders with the rove-around registrar. The ward teams seem less friendly, more intense and Dr V. and I have met before anyway, during my research. Until Paediatrics, Haematology had been my great love. Perhaps it still is — I’m not sure yet.
Being without a ward feels like being without a home. There are never any odd jobs to do - just climbing stairs up and down endlessly. There are 7 floors at this hospital. The other medical student on the unit (the one with the ward teams) told me how when she did Anaesthetics here they had to attend all the emergency ward calls and, due to the slowness of the lifts, dashed up flights of stairs to get to the patient every time.
I’ve been driving to South Yarra all week and it’s so expensive. Perhaps I should start walking, doing the cut through Faulkner Park that one should only do in good, sturdy gum boots. I used to walk across the wet lawns all the time last year on the way to meetings and turn up with leaves all over white flats, not caring at all. Now that it’s winter again, I miss them.
Prof R. works at this hospital. I past the old office all the time. Once, I came out of the stairwell just as he had walked past it but arrested, feeling like I’d dodged a bullet. I heard from his research assistant (a lovely woman from Ireland) that he’s only working 4 days a week now - what sounds like a slow weaning off from duties. When I was waiting for her in the corridor I saw a portrait that must have been taken over twenty years ago. There he was, still one of the team. Still with the network.
It feels like coming out of a bad relationship - when all the old antagonism isn’t so acute anymore and you can smile at some of the other person’s peculiarities. Retrospective appreciation. One day next week I will have to work up the nerve to go see him; I will need try and fight against being manipulated to do extraordinarily unfruitful amounts of work with no help and for no gain.
But that’s next week. For now, I have this glass of wine, this sourdough, this tomato soup and the rest of a beautiful day in June.
P.S. Been, I went to the post office last weekend and they couldn’t find a box correctly sized to fit this package thing in… so sorry about the delay! I have been looking all week and none of the post offices have it. I might give up and send it to you in a too-big box :(. It’ll be super weird, but.