life

Conversations in strange places

It’s 7pm. I’ve hung around at work well past finishing because I have a dinner date nearby and I’ve just finished up in critical care. My friend whose on until 11pm and I are sitting at the nurses station talking about life and science fiction, future plans. In the background monitors are alarming, sounds I hear as I fall asleep at night now, ringing in my ears, reminding me that medicine never sleeps.

My friend is brilliant. So keen is he to become an ICU specialist, that he has taken responsibilities far beyond the rest of us, and been rewarded with skills and knowledge that far outstrip my own. He’s waxing lyrical about laterally thinking your way through a nosebleed in a bleeder (a sick patient prone to bleeding too much), I’m having one my regular crises of confidence, the uncomfortable result of being part of a specific minority in med school that all too slowly is disappearing Right in the middle of my crisis of future failures he lands it on me.

‘Make your worst performance the best on the day’. My fugue is broken – and he explains that as the result of being forced to do high-level music for his entire life (that he says is specific to his cultural heritage), he had to take nerve racking performance exams yearly. For his whole life. That he met with prospective failure, and sometimes the reality, so often that he learned this valuable lesson. His father explained that the more you practice, the more our bring up your own worst performance, that if on the day you choke, you drown in anxiety, that even if you give your worst performance, it will be the best performance for the day.

It was one of those moments in life where you feel your mind undergo a massive correction, that ‘aha! I understand what I need to do now!’ moment. Where self doubt evaporates and is replaced with motivation and interest. Your baggage can cloud a lot for you.

In the background, a new patient is wheeled in, intubated, an unfortunate survivor of a horrific accident. More alarms. One of the nurses asks another if they want Chinese takeaway for dinner. One of the seniors wanders past and reminds my friend that a new patient has arrived, does he want to put in some lines?

We say our goodbyes, I thank him, and as he walks away he says, ‘us good people have to stick together you know’.

I swell up with pride to be counted among his own.

Fortune teller

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Every now and again we come to a time where we make Big Choices. A career, get married or don’t get married, have kids or don’t get kids, dedicate your life to becoming an astronaut. For a lot of people this happens in a nice linear fashion, go to high school, university, get a job, progress through job, maybe get married, maybe have kids.

It’s come time for me to choose a career path within medicine, except that it’s medicine which at times feels pretty much synonymous with ‘cult’ in terms of how much it takes over your life. Less helpful is the platitudes of ‘you should choose x, it’s good for women’, where x is something like general practice, or psychiatry. Such a loaded statement! ‘Good for women’ automatically implies that you are the primary carer, that it is your responsibility to choose a career, not in something that you’re in interested in, but that is appropriate for your station. Meanwhile it feels like all the guys are becoming surgeons because they feel no such pressure. Never mind the rest of us who really loved their surgical rotations and could really do that job for life, and be good at it.

It’s not the ‘good for women’ part that puts you off in the end though.

Imagine getting up at 5.30am for a 7am start every day. Now imagine that while you’re at work, you’re not allowed to sit down. You have to stand or walk every minute, all day. You might get a sit down for ten minutes at lunch before getting back up again. Now imagine your boss expects you to manage all your clients externally, and attend all the meetings and keep them happy without their input, that your performance is based on this. When you do see your boss for your internal client meetings, he stands over you and questions your detailed knowledge on everything, and consistently points out what you’re doing wrong for the hours that you are together, still standing by the way. Praise is rarely, if ever, delivered.

This picking and testing happens every day, for at least 12 hours a day, along with the standing. After your meeting with your boss, you go and check on your other clients, your patients, where you learn that one tiny mistake in theatre, one moment of exhausted distraction has resulted in someone suffering a surgical complication. Maybe you had an off moment, maybe you didn’t want to be at work that day, that you wished you could chuck a sickie – except that if you did that, everyone else’s day would then blow out to 24 hours and people who’d been waiting months for surgery would get delayed again. Whatever your moment, you’re painfully reminded that there is no margin for error, no room for an off day. And by the way, you’re on call this weekend, for it’s entire forty eight hours, where yes, you will be required to stand, and yes, you will get called in 5pm Friday and not get home until midnight Sunday where your regular working week will start anew. And you have a lazy intern who hasn’t done anyone’s paperwork so as well as checking forty inpatients (think forty client meetings in one day) you have to write a bunch of discharge letters, and get into theatre with your boss where he will lean over you, test your knowledge relentlessly and tell you everything you’re doing wrong. Until 2am.

So maybe you love surgery, would be a great surgeon, but would you put yourself through that for the next 6 years of your life? Forget your future kids, would you want that for yourself? In medicine, things like prestige and money fall away for most of us in the face of what we want from our lives. What we want from our day. We are always told ‘look at the life your boss has’ when choosing, and decide if you want that. Then you have to fit relationships, kids, and friends and anything else that’s important into that.

I read an article a while ago written by a pediatric heart surgeon who said that while it was nice they were so well celebrated and had achieved so much, that in the end it wasn’t worth it. They’d missed out on friendships, relationships, and woken up with all a whole lot of prestige and not a lot of anything else.

These lessons can be applied to any career, not just medicine. I’m still in the process of choosing, of working it out. I have an idea of the direction, but it’s the details, it’s the cult of medicine that gets me. Who knows if it will work it out?

Sometimes you just have to pick something, give it a red hot go, cross your fingers and hope the rest of your life fits in. The universe will always conspire to help the dreamer.

My Ecology

You died. You bloody died! You weren’t supposed to die. You were supposed to be the part of the story where I learn the true magic of modern medicine, the Saving Lives dream come true. But you died.

My history of you begins with the bat phone. It’s really called that. Loud important noises go off, the two way radio gets picked up, the story begins. An electronically transmitted ECG appears on the screen. It’s bad. It’s real bad. My registrar tells me to go to the resus bay and I busy myself setting up stuff to put a line in and get blood. Needles, tubes, alcohol wipes. And then you’re there on a stretcher, eyes wide open, scared. You’re barely moving. You’re talking two words at a time. People are everywhere, fussing with breathing gear, setting up for an ECG, attaching you to monitors. The boss is shouting orders. I shout back that I’ll get a line in. My reg leans in and says “are you sure can do it fast?”. I nod yes. It’s automatic. Immediately I doubt myself, I’ve only tried one line this large before and it was such a horrible painful failure that I never tried again. But this time it’s different. The line goes in immediately.

We push in fluids, the cardiology team arrives, time for you to go upstairs. Upstairs. The magic life saving place that is the cath lab, where truly broken hearts get fixed and where you’re supposed to live. You’re only young. Your wife and daughter appear as you’re being wheeled away. The boss stops the bed moving for a minute so they can have a moment. An eternal moment. I watch from a distance as your wife sinks into a chair and your teenage daughter stands there blankly. And then you’re wheeled away. Wow, I think. Wow. To be a cardiologist must be so amazing, because they’re going to fix that.

We go back to our other patients. Five minutes later the sound of emergency pagers ring out, reaching a collective crescendo. The team leader nurse is already halfway out the door with the portable defibrillator. She shouts at the medical student, the only one free to push the cart. He’s only just started on clinical rotations None of us doctors can help, we’re too busy with the other patients. I watch him obediently follow her up stairs.

We go back to work. Later the team leader appears. “He arrested. He’s tubed now. They’re pushing on with the angio”. Everyone agrees to find out what happened in the morning, it’s time to go home, now past midnight.

I’m at work today. I have a few patients I’m sorting out, mainly elderly people with elderly person problems. I see the cardiology registrar. I ask him. The registrar shrugs and says “oh that guy died”, and walks off.

You weren’t supposed to die.

I go back to work. The wind is out of my sails. For a minute a small voice tells me I want to cry. Another tells me it’s not my journey. Another tells me to get back to work which sounds sensible so I do. Another says nothing and just observes.

“You’ve got to learn to be more lazy”. I look up, and an intern is standing there, handing me a coffee. It’s late. It’s nearly time to go home. “you’ve seen so many patients” she says, “way too many!”

She’s right in a way. I’m not getting out on time. There’s a lot of paperwork left to do but I don’t really mind. I used to mind. I stay back and finish it. I lament my lack of thoroughness for seeing so many. I call consultants to get the patients admitted and give half baked stories but it’s late and they just want to sleep so they accept them.

I get my handbag and walk back to my car. Driving home I notice the other cars on the highway, some big, some small. Lights passing through the night.

You weren’t supposed to die.

The Scream


Years ago I went to an Edvard Munch exhibition, the contents of which spanned his life. I will never forget the room dedicated to the development of The Scream, it’s a picture which repeated itself throughout his life, but it was one of the first sketches of it, made when he was young that really haunted me.

The original drawing showed a child standing in front of a bed, hands to face, mouth opened in horror and terror in its eyes. On the bed behind the child laid their mother who had just died. Edvard was only five years old when he watched his mother die of tuberculosis in 1868 That drawing haunts me to this day, he drew it over and over again.

The famous 1898 picture has taken the fear and the horror from that child, and transferred it to another place – blood red sky, a bridge, but the emotion is the same. The saddest part, when you think about it, is that terrifying childhood thing, to, as a five year old watch your mother die, and quite horribly, was carried with him, was transplanted to wherever he was. It’s a painting that has so many layers if meaning to it but this one speaks to me the most. That monsters-under-the-bed fear of something terrible happening to your parents, and that fear coming through.

Now why you’d want that hanging on the wall is beyond me!

To end on a happy note, some of Munch’s last works were of green grass and blue skies with white fluffy clouds. His style completely changed in terms of content, suggesting that he found some peace. I so hope he did. That worst-fears-realised painting might have gone for over 100 million dollars but I like to think that Munch would have given all of his talent, fame, and money that he made, to have never had to paint that painting.

It’s the little things

This rotation I’m working 11 hour shifts. On your feet, no holds barred workworkwork 11 hour shifts. The boss cracks the whip, tells us to go faster, get people through, I swear some days I wonder if the apocalypse is here – it might as well be a scene from Outbreak out there.

It doesn’t leave much room for anything. Not much reading time, I don’t want to even contemplate exercise – just enough time to eat some food and collapse on the couch or bed, whatever’s closest. No one gives a crap about how healthy or unhealthy their doctor is. They just want to get fixed and go the hell home. Me too!

So you find small, stupid ways to live a life around it. You buy a gift box of chocolates and eat the whole box and it’s GREAT and you do so with no guilt because you’ve worked your ass off all day. And not at a computer, literally not sat all day, constantly moved around for 12. hours. Your feet feel like crazy angry people who scream at you and your back is like a prison.

Hot baths. A chocolate bar at lunch time. A roll of eyes shared between residents. The nurses finding a chair without you even asking and commanding you sit down or you’ll stuff up your back like they did theirs. You feel like a cross between a mechanic and a waitress. More chocolate. The boss saying good job. The Internet, bless the Internet which provides hours of immovable entertainment. The people on the Internet. Your blogs.

You stop sweating the small stuff. Daily slap becomes a bit of powder and a brow pencil. If you’re more awake maybe some gloss. Eating shit because the smallest of scrubs hide ALL sins. You stop worrying about being fat/thin/pretty/ugly/smart/stupid/too much/too little. It doesn’t really matter. It doesn’t really matter when a crazy guy has just shit in the waiting room or someone has a cardiac arrest in the way back from the toilet. It really really doesn’t matter. You just want to eat the chocolate, read the Internet and hope you’re not too tired for a run on the weekend, you cross your fingers that you’re moving enough to counter the bad food behaviour. You don’t care about getting fat, you fear glycemic toxicity, cardiovascular disease, impaired immunity.

But mostly you appreciate the little things. Most people blur into one. The nice ones stick out. You forget about the rest. You love chocolate and baths and chairs and the Internet and a kind word. Your family, scented anything, acts of kindness from yourself or otherwise.

The rest just does not matter.

Mrs Macquarie’s Point – A Photojourney

A couple of weeks back I went out for a birthday lunch and we entered up walking around to Mrs Macquarie’s point which offers some of the best views of Sydney you can find.

Garden Island

I can’t tell you what that important looking thing is, but there were tonnes of navy boats, which makes sense, Garden Island is a military base.

This has to be one of the most relaxing walks in history.

Woolloomooloo Bay

And from here you have fantastic and uncrowded views of the bridge.  Far, far better than Circular Quay, if only for the escape from all the tourist crap!

Sydney Harbour Bridge #1

Only Sydney!  Water over water – Boy Charlton pool is one of my new favourite places in the whole world.

Andrew Boy Charlton Pool

Just one more, because you can never get enough of it.

Sydney Harbour Bridge #2

I think I’m going to get that one printed.  Straight to the pool room it will go!

Authenticity, shame, power, and vulnerability.

Or in a longer sentence, ‘two videos you should watch right now in the following order.

The first is a video about vulnerability that went viral a couple of years ago.  I’m now reading her books, and I think she’s amazing.

The Power of Vulnerability

Link for iPad users.

The second is one she followed up with about shame, and links into my previous post about learning how that you are enough in a world that tells you that you’re not.

Listening to Shame


Link for iPad users.

I may be just a little addicted to ted.com.  These two are the ones I am loving right now, I cannot explain enough just how important her messages are.

Failure a thousand times over

I couldn’t tell you how many times I’ve failed at stuff in my life. The number is too high to count. I fail on a daily basis and the difference between me pre and post medicine is that now I realise just how important it is to fail. While I might get things wrong on a daily basis, while I need ongoing gentle correction in so many ways, it’s put into perspective by all the really sick people out there.

They’d love the opportunity to fail. They’d love the luxury of talking themselves out of a run. They’d love to have the right list of differentials for seizure. They wish they could eat till they felt sick or get a sunburn and beat themselves up over not wearing sunscreen. They’d love to fail an exam. They’d love to not feel like they were good enough but to take a deep breath and try anyway. Or even not try.

I used to be so hard on myself. So hard. I was never good enough. I was never enough. Never cool enough, thin enough, pretty enough. I wanted everyone to like me. And for a while I tried and for a while I thought I was succeeding, only to be cut down a thousand times over by someone who for whatever reason decided they didn’t like me. And in hindsight if you’d asked me what I had in common with them, the answer would have been nothing. But the problem with not liking yourself and investing your self worth in the opinion of others is that you lose yourself. You lose who you are. By becoming thin, pretty, and cool enough, your identity dissolves. Sure the crowd may like you, but who are the crowd and who are you? A faceless,shifting ideal.

I met a young woman a while ago at work. She was white blonde, fake tanned, thin, and dressed expensively. I would have thought she was cool once. She sat there and told me she starved herself and was getting her boobs done soon. That she went to the same clubs every week. She seemed so sad as she said it. I wanted to tell her that she didn’t need her boobs done, that she was a normal colour underneath that, that with her natural hair and skin, that she was enough. But that’s not my job. My job is to fix the medical problem. Which was unrelated.

When you fit right in, I don’t know who you are. I’m not sure you know who you are either. She seemed so sad.

We need to be brave enough to say that as we are, we are enough. With our kinked hair, landscape of skin, and dress sense governed by where we are, not what we read, with our own curious interests, we are enough.

And were I to ever meet you, I would accept you as you are, for who you are. Because you, as you are, are enough. Be brave enough to face it, and you’ll find out who you really are, and maybe the cool, thin, and pretty thing just won’t matter and wont hurt you anymore.

Back on the subject of failure – remember my Happiness Project?  It all fell apart with the start of a new rotation and my Mum coming to visit.  Last thing on my mind.  And where once I might have beat myself up, now I have to laugh.  I laugh at myself because how many thousands of projects have I started and never finished?  Too many to count.  And I have to feel grateful because so many people are stuck in some bed somewhere, attached to a drip and god knows what else, wishing that they too could print out a chart of resolutions and spectacularly fail in 3 days, laugh, then try again.

Run.

Any good psychologist will tell you that in times of stress you should ask yourself what you need and how to give it to yourself.  Lately at work the answer to that question has been ‘sleep’ and ‘food’ and not much else, which in itself tells you that you’re just surviving and not really living.  Asking yourself that question though is a great way to block out all the noise coming in from your senses, all those worries about what other people might think of you, and causes you to refocus things.  You distract yourself from your distractions simply by asking yourself what you need from yourself!  The answer sure isn’t “I need to be worried about that look that person gave me”, the answer usually is “well I need to go to the bank at lunchtime, and god I’m so tired, I need to sleep earlier tonight ,and eat better and etc etc”.

Sunday rolled around today and I found myself wound up and annoyed at work.  On my day off.  Who wants to be at work in their head on their day off?  So I put on these new babies and went for a run.

I didn’t run because I want to lose weight.  I didn’t run because I want to get fit or because some magazine told me I should for my ‘health’.  I ran because I wanted to feel better, I wanted to feel powerful, and I wanted to feel in control.  And I did.  And as I ran I saw people on my path, and anyone whose not that confident with exercise will understand how sometimes the people on your path can make you feel wounded in some way – but as I passed them and that automatic process of what they must think of me started, I just asked myself what I needed.  And the answer was “I need to run the f*** forwards”.  And I did.  And I forgot about the people on my path.

It’s been over a month since I did any exercise.  There was a bad chest infection in there and long hours at work.  In the past I’ve let that hold me right back and not re-start for fear of starting at the beginning again.  But this time that didn’t even matter, I needed to do this for myself, I needed to do it to feel better about things and it worked.  Maybe it’s because the act of running forces oxygenated blood to your brain and floods it with the nutrients it needs to think better, maybe it’s because you’re making a conscious choice to do something hard because it makes you feel better as well as being hard, I don’t know.  Afterwards I did a Nike Training Club 15 minute workout (longest fifteen minutes of my LIFE) which I’d been putting off for ages because it was too hard.  And it was really really hard.  I had to stop a few times.  I used to beat myself up for that.  But today I stopped because I needed to and continued because I needed to.  For me.

Then I came home and made this,

It’s salami, buffalo mozarella, watercress and heritage tomatoes on Afghan bread by the way.

So here is my challenge to you.  Today when you start to worry, when you start to wonder what someone thinks of you, when you feel unhappy – ask yourself what you need.  And remember that needs and wants are different things.  I frequently want a giant chocolate donut, but what I need is some downtime to relax and maybe some sleep to make the sugar cravings go away.

What do you need?  I’d love to hear your answers.

…and a time to die.

Recently I was on night shift, eating KFC at 3am in the common room with the other interns and joking about things that shouldn’t be joked about around food, and my pager went off.  I could dedicate a whole post to my pager and one day will, but it will mostly about wanting to throw the thing at the wall.  But this time it was different.

I rang the number, and the nurse of a certain ward answered, and let me know an elderly patient had died, and the family would like me to come up and confirm it.  A lot of the time you’ll go up and confirm it without the family present but this particularly patient’s relatives wanted to be there.  I hung up and started making my way up through the labyrinth of corridors to the ward.

I’d never certified a death before.  When I put my chicken down and told the other interns, I was met with a sombre mood, and “your first?” followed by sympathetic pats and the promise of chocolate on my return.  As I walked through those silent corridors, my heart was pounding.  What would they look like?  How did they die?  What if I got it wrong?  What if I certified them and they weren’t really gone?  What if they had a pacemaker?  All sorts of ghoulish thoughts found their way into my mind and by the time I reached the nurses station, I was a quivering mess.

The nurse on was lovely, she asked me if I was okay, and I whispered that I hadn’t done it before.  “Want me to come with you?” was met by a frenzied nod on my behalf, and I took a deep breath, hung my steth around my neck, and walked into the room to met five grown men and women in tears.  In the bed was the dearest old lady with a pretty neckscarf on, her eyes closed, her face peaceful.

I looked in her eyes, listened to her chest.  She was quiet everywhere.  When I tried to take her pulse, my own heart was beating so hard that I could feel my own through my fingers and I took it for maybe a little too long.

Are you sure?” came a tiny voice, from a grown man, and I nodded.  I told them I was sorry for their loss, and that I thought she looked beautiful.

Outside the nurse squeezed my hand and I did the paperwork.  Then I went back downstairs where I was met with chocolate and similar stories.  One intern had dreamed about his patient for a week afterward.

I will forever be grateful to my patient.  The family told me she was a lovely and kind woman and I couldn’t help but think that in death she was the same.  My introduction was so gentle by comparison to others, and she (I will never forget her name), has my eternal gratitude.