Outside ICU – part two

Continuation of outside ICU – part one. Did I mention this was supposed to be a short stopover on the way to our honeymoon?

Ward rounds

Little quacklings scurry around with their white coats and masks. I guess the big quacks are too old to scurry. There’s a squinty-eyed one with a bow-tie above her ponytail that swishes behind as she walks. Another girl (young male doctors are scarce) talks slowly and dreamily, as if she will drift into the clouds any minute. I don’t learn the medical jargon from them.

All visitors talk about 指标 but under my aunt’s command, our ward rounds are more sophisticated. We slip the friendly PCA a bottle of whisky to report the obs in real-time, at least twice a day. I’m told he’s better than the short female PCA who blatantly demands big bribes every few days because she’s looking after your relative, but doesn’t deliver.

One uncle takes his daily walk down to the doctor’s room. He’s friendly, slick and smooth – a professional middleman, or a senior consultant, as he likes to call himself. Settling confidently into a chair, he finds an obliging young doctor to log him in. Thanking them, he proceeds to navigates the electronic medical records himself, taking photos of all relevant pathology and radiology reports for the day, forwarding the 数据 into our family chat group. My aunt nods approvingly, telling us this uncle is diligent in completing assigned tasks. She turns to her own husband and says he’s good too; slow but steady. Then she points to her younger brother, my dad, and shakes her head.

Each person reviews the numbers on their phone and we huddle to discuss today’s progress – 今天的度血样饱和度,血样分压,白细胞计数,肾功能,纳,钾。。。The family is non-medical but have worked out things that I didn’t know after 6 years of medical school, such as the basics of BiPAP settings or the effect of steroids on WCC.

Visiting hour

Visiting hours start at 3:30pm but no one is allowed into ICU. The first sliding glass door opens but the second opaque door remains closed. Peering behind staff entering in and out, all that’s visible is a small waiting area with gowns and masks, which don’t seem to be used very often. Beside the door is a small square window.

Arms clamber over one another to be the first to get their mobile phones in through this window. The PCAs takes them to the patient’s bed and the video calls start. In a few minutes the two TV screens on the wall flicker on, each screen split into four quadrant. There’s a camera, similar to a CCTV camera, above each bed. You can briefly zoom into a quadrant for a better view, until another relative steps forward to click back into their quadrant. It’s like a zoo in this narrow corridor, with movement, voices and echoes growing increasingly loud.

None of the patients say much – some have tracheostomies, others are barely conscious. Initially grandpa nods and gestures to us but can’t talk with the BiPAP mask. When his numbers looked slightly better, my uncle passes a portable radio through the square window. We gather around to watch the screen – what will he do? He fiddles with it but his hands are oedematous and weak. Hands that, just a few weeks back, were nimble and clever in reviving watches, fixing zips and capturing waterlily shots. He gives up on the new toy because it’s new and unfamiliar. And because he’s tired. By this time we stopped video chats and could only send in short audio recordings or brief written notes.

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Outside ICU – part one

Prequel

The 3-day stopover this month was to see my maternal grandparents. They cry each of the few times my sister and I call, so we’re scared to do so more often. Mum was their youngest child and 白发送黑发 is a parent’s nightmare. Physically, they are surprisingly well. Grandma looks a lot like mum but I never noticed the resemblance. Though largely wheelchair-bound, she has regained some strength in her right leg with great determination and perseverance on her part. Her mind is sharper than ever.

The backstory is that grandma had a major stroke three years ago, on the first night I stayed over at their place. She was subsequently in hospital for several months and much of that trip was spent getting to know the local hospital system. Things like, how the nursing staff on the stroke ward aren’t concerned about turns or pressure ulcer prevention, until one appears; or how much nursing care is done by relatives 24/7 even when you pay privately for a patient care assistant to help. I puzzled over why normal saline was given continuously in patients tolerating fluids and why a PICC line would be inserted for this purpose; or why CTs were done in rehab every several days for at least a month to “monitor progress”. Taxi drivers and every person on the street knows why, and of course I got a sham explanation for my naive questions.

Sequel

This stopover suddenly became the trip itself when my paternal grandpa’s straightforward hospital admission deteriorated rapidly into respiratory failure.

Day one. The lift doors open to a wall outside ICU, lined with several foldable recliners – the type you would find at the beach. My aunt sits in one, immaculate hair, blue summery scarf draped across her shoulders, talking on the phone as if she’s in a corporate meeting. There’s just a slight shake in her normally commanding tone. Everyone knows she’s 领导, even in this situation. Inpatient admission at this sought-after hospital happens through money or connections… or a long wait (and not on a bed in ED). Just getting an outpatient appointment in this public hospital is like buying tickets to a concert. The 黄牛 buys all the queue numbers for the day and resells them at over ten times the original cost, splitting the profit between themselves, the hospital security and the specialist.

She’s busy calculating the amount of 红包 to give the head of department – too little is insulting and too much won’t be accepted as bribery technically does not happen in this exemplary hospital. Actually, the doctor wouldn’t have accepted any amount except that she’s doing so as a “friend”. Good doctors at good hospitals are good friends to have and my aunt has deliberately made several over the years. Life here is complicated.

Work 2018.1 – part one

End of 2018.1

It’s been awhile since my last “end of term” reflections and I’m running out of titles for them.

The other day I saw the gardener from that last post for the first time this year. He was standing back to look at and snap photos of his handiwork – after transforming a section of the dusty makeshift carpark in the front of the hospital into a small vibrant garden.

Work arrangements

I’ve had this enviable registrar lifestyle with part-time clinical and non-clinical work. Regular hours, no weekends, lunches where it’s possible to go to the bank if needed, and fairly easy negotiations for (unpaid) leave. I’m realising a few things:

  1. Many arrangements are possible in medicine, although not all are financially advantageous.
  2. A couple of part-time or casual appointments can add up to more than 1.0FTE – obvious I know, but it’s easy to think a few hours doesn’t count for anything. Managing several remote desktops, inboxes and HR systems also takes time.

Busyness

I hate it when I procrastinate but I also hate this tendency to be busy. Although less frowned upon, an excessively full calendar is as much of my failure in scheduling as lazing about and getting nothing done.

Both reflect an inability to maintain focus and discipline in life.

Focus

Speaking of focus, some of my favourite exercise metaphors (there are many) come to mind during BodyBalance classes:

  1. Staying still doesn’t look as difficult as doing weights, but requires concentration and a different kind of strength.
  2. When staying still in a difficult balance position, I have to fix my eyes on an unmoving spot. Not the instructor or person in front of me because they wobble and then I fall over too.

The second one I initially discovered from a patient rather than the gym instructor. I was removing a foreign body in clinic and despite trying to stay still, this patient’s eyes would flicker away as the needle approached each time. When he later focussed on a spot in the room the stillness was so remarkable that I thought I should try it myself.

 

Opposites – part two

In my writing

“Each time I look at it it’s a reminder that you never write to me. And that makes me feel sad.”

That was in 2009. We were apart for a year and shared a blog to keep in touch, until you forgot to write after the first month or so. Outside of textbooks and current affairs, reading didn’t interest you much. Back then I was upset and said you didn’t care about my thoughts and feelings. Your reply was, don’t you just tell me everything anyway? Even up to now, you only visit my blog every couple of years.

So initially in anger and later by habit, you’ve become strangely separate from, and omitted from, almost everything I write. In more recent years I laugh when I think of that argument because it so clearly exemplifies how different we were and still are.

缺口

When we met, you thought I was impressed with the number of push ups and pull ups you could do. But that was a big misunderstanding – I had no interest in muscles or such things and must have been watching out of sheer curiosity that someone could have fun working up a sweat. Back then you had just completed a 42km race after army, whereas I was out of breath running less than 1km around the park. I liked creative pursuits like art and music, and you were this odd Asian who couldn’t play a single instrument.

I wanted to have really loooong deep and meaningful talks and you would quickly lose concentration, or doze off altogether. Vet and medicine weren’t worlds apart as far as content goes, yet we were barely in the same space. Where I would share about some troubling aspect of hospital life or human suffering, you would respond by asking questions about some nerdy clinical detail or informing me of the pathophysiology of what was going on.

Needless to say it was endlessly frustrating and we fought all the time. I’d say we’re opposites and couldn’t work out and you’d say that opposites are complimentary. In the years to come we would become more similar as we cottoned onto each other’s interests and ways, but would both come to the conclusion that neither personality differences nor similarities are inherently advantageous in a relationship.

最亲爱的你

Over these years, I’ve also grown to appreciate our differences. I appreciate how you’re exuberant and excitable about life, whereas I’m often troubled and tired, pondering on the meaning of our existence. Where I could be more correct in almost every argument, you would almost always be kinder with your words. Where I might hold a long grudge, you have the gift of forgiving and forgetting. Where I am cautious to be emotionally invested, you’re somehow able to be single-minded and unreserved in declaring your love. Where I want to run away from something difficult, like marriage or children, you would say you like a challenge.

You’re like sunny Sydney and I’m like moody Melbourne. And you would say that the world needs a bit of each.

As far as humans go, you are the most constant person in my life and I often forget how much strength that gives me in my family life, ministry, work, friendships and all the areas people perceive me to be strong, capable and independent in. Thanks for walking with me and choosing to keep walking with me.

Thanksgiving and lepers – part two

For part two, in response to the prosperity message, I had in mind to highlight some instances in the Bible where things didn’t end well. But I didn’t end up writing much on that and wrote instead about feeling leprous on mother’s day.

Didn’t end well?

  • John the Baptist – he lived in Jesus’ time and was his relative. Jesus healed the sick and raised the dead. But John’s head was brought out on a platter, to a girl and her vengeful mother.
  • Stephen – in Acts lots of miraculous deliverances happen for Paul. He walked out of prison, was saved through shipwreck, and wasn’t affected by the bite of a poisonous snake. But what about Stephen who was stoned in the middle of his sharing?
  • Jesus – the Jews did not think the anointed one could die on the cross. Islam also does not see it fitting for God’s prophet to die on the cross, with the Quran saying it merely looked like Jesus died on the cross. But Christians say Jesus, being God, died on the cross.

Of course the difference with the third example is that Jesus’ story did not end with death on the cross. I guess the same could be argued for John, or Stephen, or all of us.

“So we are rebuked by Qohelet [the preacher, in Ecclesiastes] for our tendency to take wisdom’s remarkable sense of universal order and to turn it into a world-view which lacks depth, and which has no answer, other than condemnation, for the person whose experience contradicts it. From the New Testament perspective it is true to say that we can know with certainty that confusion and futility are banished by Christ. But until he comes again and all things are renewed, faith in the grace of God must sustain us through many incomprehensible tensions in our experience.” – Gospel & Wisdom, Graeme Goldsworthy

Still feeling leprous

I’m not sure if it’s because our expectations for Christians are different, but we often feel most “leprous” at church.

Last week my sister was singing “I love my mummy” with the other Sunday school children in front of the congregation. They had been practicing for a month or so. Each child was given a little card to take to their mums or another mum in the congregation. C ended up giving it to the first person in the front, who is a family friend with a daughter studying interstate. She remarked with a little laugh, as if surprised, that C was looking around a bit and wasn’t sure who to give it to. I wish she gave C a hug instead.

The godmother of two toddlers, whose mother died in surgery last year, did give us a hug though. And the new pastor’s wife came up to say she’d like to have us over for a meal some time.

My sister is a happy chirpy girl and a little oblivious to all this, but I feel so sad for her that most grown ups at church can’t stop to acknowledge or ask about her feelings. Sad, maybe angry, for myself too. With my own peers I’ll put it down to not having reached a stage in life to understand these things. But these are mum’s many friends who were close to her for years and years. We see them every week but it feels that the relational ties ended at her funeral. Or they feel too awkward to speak to us.

I’m sure there’s plenty of people feeling a loss on these type of occasions. When I made that remark at work my colleague helpfully pointed out that other people do have tragedies, but your grief is always the heaviest (because it’s the one you carry).