An afternoon at the beach (II)

sitting on the bay
Originally uploaded by Sunshine follows me.

In answer to all the queries on my previous post...

1. It is indeed turning towards autumn, with the cool evenings and mornings, but it doesn't stop us from going to the beach! People over here visit the beach even in the middle of winter, wearing heavy knit sweaters and coats, just to enjoy the smell of the sea and the sound of the waves! It was a lovely warm afternoon when we went - but I brought a cardigan along in case it turned chilly.

2. It was a little chilly for ices (in my opinion, although the other Brits were happily munching on their cones) so we had chicken and chips instead. A lovely hot crispy chicken cutlet, and lots of vinegar on the chips, sitting on a wooden bench and enjoying the breeze.

3. I don't really visit the beach to ogle at the hunks and babes. Most of the people on the beach were elderly folk with dogs or middle aged couples with young children (hunks and babes don't hang out at uncool places like the beach - they are busy getting prepared for a Saturday night of debauchery). In any case, I'm normally the one being ogled in most outdoor situations - probably because I'm the "exotic oriental girl". You know us Southeast Asian ladies are highly in fashion nowadays! I must admit that I do enjoy people watching in general, though - but only because it's fun seeing how individuals interact with each other.

4. I thought the view was fantastic. I guess you have to know where you are looking, in order to appreciate the British beach. Sea for miles and miles, windsurfers and sail boats on the water, towering cliffs behind me...it was beautiful.

An afternoon at the beach (I)

What's in a beach bag
Originally uploaded by Sunshine follows me.

So I'm working the 6pm to 2am shift, but it doesn't mean that I have to stay indoors all day! The beach is only a 40min drive away, and it's a warm afternoon.

MDH leaves the packing to me and he is always amazed at how much I can squeeze into a small cloth bag. I say that anyone can be Mary Poppins if they just know how to pack.

We have brought:
2 pairs of sunglasses
2 novels
1 Bible
1 notebook
1 wallet
1 small towel
1 packet of tissue paper
1 bottle of sunblock
1 tube of hand cream
1 tube of hand disinfectant
1 camera
1 hat
1 beach mat
1 large bottle of orange squash

And we're all set for the beach!

An evening in Minors

Last night I saw:
4 head injuries
3 sprained ankles
3 infected wounds
2 abcesses
2 sprained shoulders
2 broken knees
2 sprained knees
2 badly bruised elbows
1 bad back
1 swallowing problem
1 sprained wrist
1 sprained elbow
1 broken toe
1 impacted wisdom tooth (next time see the dentist!)

I have learned:
1. Always wear seatbelts
2. Between a head and a glass bottle, the bottle always wins
3. Never attempt a kamikaze stunt on a bicycle
4. Let sleeping drunks lie
5. Don't ever dance on the glass roof of the greenhouse

What the...?

So I'm talking to a boy with a sprained ankle, when this woman comes bursting into the room screaming, "I need 300milligrams of aspirin NOWWW!!" and then bursts into tears.

The nurse goes over to talk to her and she blubbers out her request. She wants 300milligrams of aspirin, crushed into a powder and sprinkled over bread.

What the...? Can you repeat that please?

300 milligrams of aspirin. Crushed. On bread.

The nurse asks her why. And she points at the door dramatically as a man walks in bearing in his arms...

The sickest Westland Terrier I have ever seen.

The fellow puts the dog down. And the dog heaves a steaming puddle of vomit on the floor, and then cocks up his leg and proceeds to redecorate the walls.

What the...?

We had to turn the poor sobbing woman away, saying that we didn't want to be responsible for giving the dog anything that might possibly make it worse.

This is a hospital, for crying out loud! We deal with humans, not animals!

Beefcake!!

Homemade burgers, originally uploaded by Sunshine follows me.

Today, we made our own burgers from british grown choice beef mince (we scoff in the face of BSE), onions, eggs and breadcrumbs, seasoned with worcester sauce and touch of nutmeg.

MDH decided to make sauteed baby potatoes whislt I grilled the beef patties on the George Foreman. The sesame seed buns were lightly toasted before smothered in ketchup and a thick layer of mature cheese.

Burgers.

Apple juice.

David Bowie.

It's gonna be a good evening.

Not part of my job description

I've drawn the curtains round the trolley that the old man is lying on. He is refusing to look at me. I ask him what happened. He does not answer. I pull up a chair, and sit next to the trolley and wait.

3 minutes of silence, then he starts to speak. His voice is soft and calm, with a rasp in it that makes me think that he hasn't spoken in days or weeks.

He'd been thinking on it a long time. Weeks. Months, really. Perhaps almost a year. Ever since he realised that his hands had begun to shake so much that he could no longer shave himself. But he'd only started planning a few weeks ago.

He started stopped taking his painkillers. Hid them behind his bedside table instead. Then, when his wife was out, he walked down to the cornershop and bought a bottle of vodka. It took him two hours to walk the 100 metres there and back. He had been getting alot worse lately, even when using a zimmerframe. The bottle of vodka was hidden behind a bookcase in the spare room.

He waited until the day that his wife was visiting her sister. She would be gone the whole day. She left early in the morning, when she thought he was still asleep. He wasn't.

When he heard the car drive away, he got out of bed. He washed himself with great difficulty. Then he got his hidden stash of tablets and started taking them, ten at a time, with large mouthfuls of vodka. He finds it very difficult to swallow nowadays, so it takes him a few hours to finish up all the tablets and all the vodka. He leaves a note on the dresser for his wife.

And then he lay down in bed and tried very very hard to die.

But it didn't work. Instead, his wife came home late into the night and found him, still alive.

Now, he looks at me and says, "Can you help me?"

And I say, "I'm sorry."

And he turns away and weeps.

I stay and put my hand on his arm until he falls silent. I set up a drip with antidotes in it.

And I go back to my desk, reach for the phone, and call the psychiatry team.

I feel miserable for the rest of the day.

I hate it when this happens.

5 quirks tag

Here is a tag from jadeite that I promised I would complete - sweetie, I hope you get the internship that you wanted and I hope that your beloved learns how to cook buttered mushrooms too.

5 quirks:

1. My voice changes in pitch depending on who I'm talking to. It's low and husky when I talk to my family. It's medium and sharp when I talk to my patients. It's high and musical when I talk to my friends. MDH gets a multi-super-combination of all of these, and it often confuses him.

2. When I sleep, I really sleep. You can shout in my ear and shake me and pick me up and drag me around the house and I'll still be asleep. People often marvel at my ability to fall asleep anywhere and remain unrousable. Sometimes, they even think that I've passed out.

3. I grow my hair out long so that in the event that I am highly stressed or frustrated, I can march into the hairdressers and say dramatically, "Cut it all off!!".

4. When I get PMS, I always end up listening to Jewel and I always cry whenever she sings 'Painters'.

5. When people talk to me, I often unconsciously mimic their lip movements, especially if I'm concentrating very hard on what they are saying. Teachers at school used to get very angry at me because they thought I was talking in class (bad) or mocking them (worse).

5 people I'm tagging:
Darn, you all ran away too fast. I was always slow on my feet.

Pashupatina

pashupatina, originally uploaded by Sunshine follows me.

I have been so distracted by this website. I keep coming back here to visit and admire Natalie's latest pieces. I love the way she combines and mixes colours and materials.

Most handmade necklaces I've seen are just circles of beads but these unusual necklaces have each got a distinct asymmetrical form that draws the eye towards the unique details of the beads used. Each piece of jewellery seems to have a distinct personality, and I find that I am attracted to different necklaces, depending on the mood I am in.

Today, I am feeling rather happy, and am drawn to the pale pink one, and the green one with the little white bunny.

What is an illness? (II)

Wahj made an insightful comment on my previous post regarding the definitions of mental illness.

"There's an increasing tendency to "medicalise" things and treat them as disorders and sicknesses. While doing so gives recognition to the problem, and is helpful insofar as it highlights it, it moves into the medical realm (e.g. treat with drugs and chemicals) what used to be dealt with in the social realm (address with behavioural influences).

I was also thinking of the increasing number of kids now labelled ADD in our schools. I don't think there's something in the water thats causing it, for example: it's just a case of children who in the past would've been labelled "incorrigible" and undisciplined now being recognised as having a disorder.

What I worry about is that once we medicalise a person and his/her problems, we assume that the only solution is medication, and ignore the fact that these problems are part social, part pyschological, part physiological."

Now, I totally agree that some people, after being diagnosed with an illness, will automatically attribute all their life's tribulations to the workings of the disease. So many times, I have patients coming in to see me, expecting to see their social problems disappear with the treatment of their physical problems.

However, I think there is a case for identifying people who need assistance from a professional, and sometimes it helps to have a diagnosis, a label, because that gives an answer to the question "What is wrong with me?" and this is often the first step to recovery. People who come to see doctors often don't have an adequate social network that has the strength, knowledge or the resources to cope with their afflictions.

I am very glad that Wahj has chosen to use ADD 'Attention Deficit Disorder' (also known as 'ADHD' or 'Attention Deficit and Hyperactivity Disorder') as a case to illustrate his point. I actually have a very deep personal interest in children with ADD, having had the opportunity to followup several children with this disorder over a minimum period of 5 years.

ADD defined as a triad of hyperactivity, impulsivity and distractability. It is only diagnosed in children of school-going age (ie. after the age of 5), which is why most teachers tend to view this disorder with rather a jaundiced eye. There are still alot of people out there who are very skeptical about the existence of ADD - but I can assure you that ADD is real and children who have it do need help.

ADD is a developmental disorder, much like autism. Unlike autism and other developmental disorders like dyslexia, ADD is not yet socially accepted. Autism when reduced to bare bones, is a failure of development of emotional centres - which is why children with autism often are unable to socially interact. ADD, however, is the failure of development of concentration.

The failure to develop adequate concentration skills means that the ADD child has learning difficulties. This does not only apply to learning from books, but also learning from observation and deduction. 'Behavioural influences' will not teach this child anything because they won't be able to pick up the subtle cues. Thus, the ADD child does not learn important and very basic social skills, and this leads to inappropriate behaviour.

Now, one of the differences between the ADD child and the 'incorrigible' child is that no amount of good parenting or discipline will change the ADD child. The ADD child does not understand when they have done a bad thing (good example: Getting up and walking around the class whilst the teacher is still talking) because they have not learned what is socially appropriate. They simply have not observed that nobody else behaves the same way they do because it is unacceptable to do so. Disciplining an ADD child often has little or no effect, because they have not fully understood why they have been naughty - so instead of feeling sorry or guilty, they feel incredibly maligned. Worst of all, because they still haven't learned what they did wrong, they are likely to repeat the bad behaviours time and again.

The ADD child is an exasperating child. They fiddle and fidget. They often do incredibly stupid things for no reason. They are easily provoked. They get into trouble. They don't know the difference between 'silly' and 'irritating'. Exasperated parents will say "Grow up!" or "When will you ever learn?", exasperated teachers will say "Apply yourself!", exasperated peers will say "I hate you, go away!".

The ADD child often does poorly in school and has no friends to speak of (it's difficult to tolerate their inept and awkward behaviour - especially their lack of respect for personal space, and their bizarre multi-conversations about several topics at once). Everyone around them appears to dislike them and yell at them alot. You can understand how the ADD child will have really low self-esteem. It's a pretty sad situation to be in for a small kid.

The second difference between the ADD child and the 'incorrigible' child is the effect of pharmaceutical treatment. The drugs used to treat ADD will only work on ADD children - in a normal person, the medication (which is similar to amphetamines or 'speed') will only worsen hyperactivity and impede concentration, but paradoxically, it works to calm down a person with ADD.

In calming the child, it gives them a greater ability to focus their minds so that learning can take place. I am always amazed at the efficacy of ADD treatment - results can be seen in less than a month (Fewer phone calls from angry teachers, fewer accidents in the household, grades at school seem to be picking up, child actually seems to be absorbing what you say).

This, of course, does not mean that all the changes can be solely credited to the effects of medication. It is up to parents and teachers to encourage the child's newfound focus in the right direction. It is totally up to the child to motivate themselves to work hard in order to change. The medication is used to 'buy time' whilst the child's concentration ability develops to a more age appropriate level.

It is probably true that ADD kids, if left to their own devices, may eventually develop enough concentration skills to be able to cope socially. But this could take years, and a kid with a poor school record will be greatly disadvantaged - especially in an unforgiving society like Singapore, where performance first few years of schooling has a great impact on the sort of educational opportunity a child will have in the future. What good would it have done to label the child 'incorrigible' or 'undisciplined'? Would that have brought any benefit to the child? At least with pharmaceutical intervention, we are giving that child a chance.

The idea of medical treatment is that it is used as a stepping stone, to bring a person to a level when they can begin to deal with the difficulties that they are facing. The medical profession is often used as a resource to access other services - counselling, behavioural therapy, support groups, social workers and health visitors - that can be helpful to the patients. But it is the patient who is ultimately responsible for their own personal trials. Doctors are only helpers; it is the patient who must battle their own demons.

It is also useful for a person to be able to name their afflictions. Naming it means that you have power over it. Having a diagnosis gives the person something more tangible that they can deal with. It gives a family hope that there is something that can be done and shows them what sort of special needs a person may have, and how to manage them. It also brings awareness to other people who can in turn respond with understanding, and maybe even a little forgiveness.

Mooncakes

It's Mid-Autumn festival.

I have no lanterns, no mooncakes, no piglet shaped biscuits.

I am terribly homesick.

Beware the Killer Granny

94 year old lady sitting in the cubicle, surrounded by a cloud of twittering cotton haired women in pastel cardigans.

As I approach, the pastel cloud begins to hum and move around me.

"I saw it all!" Pink says, waving her arms in the air.
"They ran her over!" cries Yellow.
"Now she's hurt her leg!" moans Green, pointing at the limb in question.
"Young people nowadays..." Blue says, shaking her head.

94 year old lady, in a cream cardigan, lies back on the trolley, closing her eyes and doing an excellent impression of a dying swan.

It transpires that Mrs Cream and her friends had met up with a bunch of frivolous youngsters, and one of them had run Mrs Cream over with a scooter.

When I say 'Scooter', what I really mean is 'Motorised Wheelchair'. Moving at 2-3mph.

And when the Pastel Posse tell me that they encountered 'youngsters', what they really mean was a 67 year old and her mob of tartan skirted gangsters. Oh, those whippersnappers!

The said 67 year old is being seen by my colleague in the adjoining bay, having been smacked in the legs by Mrs Cream's shillelagh. ('Rogues!' she screams, shaking her fist at them whilst the Tartan Team dart angry glances in my direction.)

Fortunately, neither of the ladies were seriously hurt, and the Pastel Posse and Tartan Team leave the department, snarling at each other on the way out and shaking their zimmerframes menacingly.

Woe betide anyone who provokes these feisty women. They may be frail, but they pack a wallop. Literally. I bet Mrs Cream has a mean left hook.

What is an illness? (I)

Mrs Budak made a really interesting comment about my Van Gogh post:

'What exactly is mental "illness"? If a brain is somehow wired differently, can it be called an illness? Because of this different wiring, some mental illness sufferers are able to see the same things from a totally different dimension. Creativity can come from madness, it seems.'

Now, I personally believe that everybody has a brain that is wired in a totally unique way, and that we all have our little insanities. We all perceive the world in a different way from the next person.

'Mental illness' results only when the thoughts or beliefs of a person interferes with their lifestyle and from performing very basic functions - eating, sleeping, interacting with other people for example. That is, it's only an illness when the person in question isn't able to manage and are either a danger to themselves or to the people around them.

My Van Gogh, I believe, was doing quite well for himself in the battle against his personal demons...but then it all got too much for him. Looking at him, I don't think he had any sleep for four days and probably hadn't been eating. That is mental illness.

I think there are many people out there who manage to cope with a little madness, so to speak. Look at the artwork of artists like Salvadore Dali and Picasso - I'm not sure they were ever treated for a mental illness, but the sort of artwork they produce (pretty scary, don't you think?), the eccentric and bizarre behaviour they are reputed to have - well, they could almost be any of the patients I've met in the psychiatric unit.

Consider the nightmarish, horrific imagery of authors like Stephen King or Edgar Allen Poe, the histrionic popular Hollywood stars and their addictions.

"A Beautiful Mind" is one of the movies that comes to mind that illustrates how person differs from patient. The brilliant scientist with his idiosyncracies and his imaginary friends vs the confused and paranoid man. It was when his life began to fall to ruin that he was identified to have a mental illness.

Mental illness doesn't exist in someone who is able to cope with life and the pressures of the world. Mental illness is in the person who is broken, whose life has shattered, whose thoughts are splintered.

Engin Rosak, they say.

In other words, we don't fix it unless it's bust.

Seven

So I've been requested to do this (very long and tedious!!!) meme by fortycalibernap - I hope you are feeling happier and I would like to see some smiles from you, if that's not too much trouble. And thanks for saying nice things about me on your blog.

7 things that scare me:
1. Cockroaches
2. Babies that vomit blood
3. Snarling, mangy dogs
4. The sound of footsteps behind me when I walk home at night
5. Men who cry
6. Angry relatives
7. Angry nurses

7 things that I like most:
1. The sound of babies laughing
2. Playful cats
3. Dogs with waggy tails
4. Icecream
5. Choral music
6. My hair
7. Long showers

7 important things in my room:
1. Bible
2. African violet pot plant
3. Bedside lamp
4. Alarm clock
5. Mirror
6. Cotton rug
7. MDH

7 random facts about me:
1. I sing in the shower
2. I love my sleep
3. I cannot abide tardiness
4. I'm allergic to shellfish
5. I'm addicted to mashed potatoes
6. I read through books at least twice
7. I get really grumpy when I'm hungry

7 things I plan to do before I die:
1. Visit Petra in Jordan
2. Learn to surf
3. Take art classes
4. Learn the history of Britain
5. Have babies
6. Learn to salsa
7. Understand the Bible

7 things I can do:
1. Be tactful
2. Make meatballs
3. Get angry
4. Cry at will
5. Perform well at interviews
6. Smile in the face of death
7. Give massages

7 things I can't do:
1. Drive fearlessly
2. Chat with shopkeepers
3. Talk back to my parents
4. Indulge in retail therapy
5. Give money to beggars
6. Bake cakes
7. Express my anger

7 things I say the most:
1. "I'm hungry"
2. "Take some deep breaths now"
3. "I don't want to go back to work!"
4. "WHY?!!"
5. "This is ridiculous."
6. "What day is it?"
7. "Chocolate. Now."

7 Celebrity Crushes:
1. Johnny Depp
2. Colin Firth
3. Orlando Bloom
4. David Bowie
5. Harry Connick Jr
6. George Clooney
7. Adam Sandler

7 people who could do this:
1. Tym
2. Wahj done
3. Jadeite done (I noticed your tag too - I will do it soon, okay?)
4. wuyuetian done
5. Aleej
6. Budak done
7. Maria

Update: Links changed for those who completed the meme!

Van Gogh in the department

A young man, quiet, sitting silently on his trolley. His arms are covered in spirals and patterns that seem to twine and coil up his limbs, the brilliant colours shifting and blurring as he moves. He is dressed simply and it is obvious that he normally looks after his appearance - his hands have the roughened appearance of a manual labourer, but his fingernails are meticulously clean and neatly shaped. Streaks of blood have dried on his cheek and beard and in spatters on his jumper.

He looks into my eyes for a brief second, and then stares rigidly into space, as if eye contact was too pressurising. His face is expressionless and blank as he answers my questions.

'I cut my ear. With a bread knife.'

I examine his ear. He does not flinch when I peel off the makeshift dressing he's made, even though a few hairs rip off at the same time. The wound is not bleeding much anymore, but he has almost cut his entire ear off. It's still mostly attached, but not by much.

'It will need stitches,' I tell him, 'But it's too deep for me to do it; I will have to ask the general surgeons, or maybe even the plastic surgery team.'

He assents. His expression does not change. I ask if he's in pain and offer pain killers. He does not move or respond. I tell him that he can ask for pain relief at any time.

As we talk, he tells me more about what has transpired. He suffers with schizophrenia but has been quite well for the last few months without medication, and thought he was free of it. But lately, the voices have returned and they were so loud that they drove him to distraction, drove him into despair, until finally he thought he could rid himself of them by cutting his ears off. He was halfway through when he realised what he was doing and called the ambulance.

His voice is monotonous and heavy, with no inflections, as if it was weighted down by lead.

I ask him about his tattoos. He tells me he designed them himself. I look hard into his face, wondering, hoping even to see the faintest glimmer of pride - but there is nothing.

After we agree on a plan, I leave Van Gogh alone, as I make arrangements to have his ear fixed and for him to speak to our psychiatry liaison team.

It's a very curious disease, schizophrenia. Reality for the schizophrenic has become shattered to such an extent that one cannot ever hope to fathom or empathise with what they go through. People with depression and anxiety and other 'emotional' disorders, we can understand and even identify with them. But psychosis is a realm that most of us have never explored.

There's a theory that schizophrenic patients have difficulty recognising and identifying their own thoughts - that is, they confuse their inner voice with outside stimuli. Imagine if you believed every train of thought in your head had an actual sound that you could hear with your ears. How noisy that must be!

I can hardly imagine what it must be like to live in a distorted and utterly confused world, where reality and dreams are mixed in together in kaleidescopic whirls. It would be so frightening and disorienting.

I remember the paintings I've seen in museums and on postcards - the swirling colours both brilliant and sad. I look at the tattoos on Van Gogh's arms - the deep bruised blues and pale cadaveric greens. I think again about the partially severed ear and the blank, emotionless face, and I know he's trying to tell me something.

I listen and listen.

But it is as if my ears have also been cut off, and I cannot hear him and I cannot understand.

MDH and the Five O'Clock shadow

MDH in South Park, originally uploaded by Sunshine follows me.

Here is a portrait of MDH at 7:30pm after spending the day fighting death and traffic ("I drove the whole way home behind a freaking tractor that was going at 20mph!").

MDH took one look at this picture and complained that (a)I didn't post it up on my website and (b)he's not always as grumpy as that.

Self-portrait

tscd in South Park, originally uploaded by Sunshine follows me.

Here is a picture of me in my Emergency Department scrubs and purple latex-free gloves, standing in the Doctor's Mess. You can tell I've been having a very hard day facing many SSPs.

(Check out the South Park Studio! - thanks to DJ Slapdash for the link.)

Different needs

scenario 1:

It's been a bad day at work. I haven't had a break or eaten lunch or drunk any water all day. I come home, feeling utterly spent, and there's a wonderful smell of sizzling butter-fried mushrooms and grilled sirloin steak. MDH gives me a big hug and pours me a cold glass of orange juice. I have a shower, and then we eat dinner. MDH massages my feet with oil, talking to me all the time. I feel smothered with affection and attention. MDH cuddles me all evening. This is how he loves me.

scenario 2:

It's been a long evening. The dinner I've made has long grown cold. I'm checking my email. MDH trudges in, looking grumpy - he's had to do some overtime at work and traffic was bad on the way home. I smile at him, give him a big hug and then heat up the dinner. MDH wolfs dinner down whilst reading a few chapters of his book. He has a quick shower, then lounges on the sofa for the rest of the evening hooked to the Playstation. I let him alone - he needs space to unwind by himself. The evening goes by in a comfortable silence. This is how I love him.

Being sociable

Sometimes I am so tired after work, I just want to curl up in flannel pjs with a mug of hot chocolate and a book. I don't want to make the effort to go out, meet friends, and have a laugh over dinner and drinks.

Today is one of those days.

I know if I don't go, I'll regret it. I seldom get enough time off in the evenings to meet up with friends.

I really want to go to sleep.

But I really want to be sociable and strengthen my friendships.

And I'm sorely in need of a good laugh.

Right. I'm going.

Good sounds

Here are some sounds that make me feel very happy:

1. "Thonnk!" (sounds like a metal spoon hitting a wooden spatula).
The highly satisfying sound made when I relocate a dislocated finger or pull a wrist fracture straight. This sound also makes my patient very happy - because suddenly the pain just goes away. When the bones are still dislocated, patients can be in so much pain that they require morphine injections. After the pain is relieved, the morphine no longer needs exerts it's analgesic effect and my patients fall immediately into an opiate-induced (and usually well-needed) sleep.

2. "Fsss..." (sounds like air escaping from a balloon).
This is the sound made when a collapsed lung is reinflated. Sometimes, when a lung is punctured, the air escapes into the cavity surrounding the lung and this air is trapped and cannot escape (pneumothorax, for those of you who are interested)- it squashes the actual lung down and the patient becomes short of breath. Ordinarily, lungs will repair and reinflate themselves, but occasionally, the lung becomes so small that we have to give it a little help - by inserting a needle into the lung cavity, decompressing it. I often feel very relieved when I hear this sound because it means we've got the needle in the right place.

3. "Shfff" (sounds like a refridgerator door opening).
This is a cannula being flushed - which means that it is in the right position. It still gives me a kick to be able to put cannulas into veins - probably because I used to be very bad at it when I first started. The first time I got it in, I felt a great sense of achievement because it is one of those painful procedures that usually form a necessary part of inpatient treatment. Now that I am good at it, everytime I get a cannula in, I still feel that exhilaration just knowing that intravenous treatment can begin - I can put up a drip or give antibiotics or a shot of painkillers - and that my patient will start to feel better soon.

4. "Thank you!" (self-explanatory)
It's nice to be appreciated. Not very many of my patients bother to thank the nurses or doctors anymore. Especially not the doctors - nurses tend to be the ones who get most of the grateful smiles and handshakes (and rightly so, considering what they have to do for their patients). Doctors tend to be viewed with rather a jaundiced eye - we are the enemy who jabs them with needles, pokes them in painful places and puts them through nasty, uncomfortable or embarrassing procedures. Doctors often the bearers of bad news or harbingers of death or fearsome disciplinarians. It's very difficult to see that doctors and patients fight on the same side. But there are some people who appreciate what little help we can give - and it's nice to know that we've done something good once in a while.

In the midst

It's quarter to midnight. The department is packed as usual, and this evening I've seen two broken wrists, three broken noses and one broken jaw (it's funny how fractures seem to all come at once).

One of the senior doctors is celebrating her birthday today (the big Four-Oh) - and she's working the night shift. So at midnight, we're all going to give her a big surprise cake.

Everyone has brought some food from home - biscuits, cakes, sausage rolls, potato crisps, fizzy drinks. We're smiling although it's been a busy evening, because there's something to look forward to. A little celebration amongst colleagues.

It's nice to know that somehow - even in the midst of suffering - we can still rally together and bring some joy into each other's lives.

Still horrified

I hate starting twilight shifts, because I have to nap in the afternoon. Quite often, I have quite nasty and disturbing dreams when I fall asleep in the afternoon.

I'm obviously not recovered from yesterday's horror, because that's all I dreamt about today, over and over again.

Horrifying

A young woman in her third pregnancy.

She came to me because she had been having some abdominal pain and bleeding. Alot. Clots.

Sometimes, it is possible to have a tiny amount of bleeding in the early stages of pregnancy. It's when the bleeding is heavy or is accompanied by pain...that's when you get worried.

I tried to prepare her for the possiblity of a miscarriage. We both knew that the pregnancy was most likely lost, but she clung onto the hope that maybe, just maybe...

I arranged for her to have an urgent ultrasound scan at the early pregnancy unit.

I had just finished speaking to the Obstetric team when she started to scream.

Quickly, I dashed into her cubicle.

To find her choking in anguish, holding in her hands out, covered in blood. There was blood in puddles and dark clots on the floor. She was crying out, "So much blood! I couldn't stop it! My baby is dead, isn't he? Isn't he?". Her eyes were wide and reddened.

I brought her a plastic bowl and she emptied her hands into it.

And then I saw it, but didn't say anything.

A minute transparent hand, lying on the surface of one of the clots.

I looked up at her and saw that she had curled into a small ball, clutching her tummy as if she could hold in her baby that way. I knew it was too late, but I also knew that it was not the right time to confirm her fears. I hoped that she didn't see what was floating in the bowl.

I covered the bowl with a piece of cloth, and then spent the next 5 minutes holding her hand. As the porters came to take her away to the wards, I surreptitiously gave them the bowl to bring with them.

I hope she never saw it.

And I wish I hadn't.

smallthings by Teresa Robinson

smallthings, originally uploaded by Sunshine follows me.

These are truly amazing pieces of jewellery - beautifully handcut into tiny slabs of silver and then layered over a piece of stained glass to bring out the delicacy of the image.

I love the intricate detail that is in each little picture - the jagged edges of flower petals or the veins of an insect's wing. It just makes me think of all the attention each little piece has been given. I also like the way that each image comes in a selection of styles and colours - so can be personalised to the customer's particular taste.

The best part is, for this week, Teresa is giving half of her proceeds to the hurricane relief fund of Mercycorps. So now you can buy stuff for yourself and feel altruistic at the same time. Go have a look at her wares!

Whatever happened to discipline?

Whilst flicking through my usual daily blogreads, I came across this post which reminded me of a little scene I witnessed between a mother and daughter not too long ago.

MDH and I were at the post office queueing up for some stamps. In front of us was a mother in her early thirties, who had come with her little eight-year-old daughter. The little girl was a few feet away from her mum, browsing quietly through the post office shop which (amongst other things), sold some children's toys.

Little Girl picked up a doll, looked at her mum and said, "I want this doll."

You could tell from the tone in Little Girl's voice that she was a highly experienced fighter when it came to the battle of wills.

Mother looked at her, saying "No. You already have so many dolls at home. I'm not buying it. Put it back."

Little Girl says, "I want this doll; it's mine."

Mother says, "But I already bought you something today. Don't be naughty. Put it back now, please."

Notice, if you will, that Mother is pleading with Little Girl. Little Girl isn't shouting or crying - she is speaking calmly.

Little Girl says, "No, it's my doll. I want it."

Mother says, "If you don't put it back now, no more television when you get home."

Little Girl walks up to the post office window and puts the doll on the counter. She is perfectly calm. She knows the doll is already hers. The Mother turns pale. We all know that she is going to have to maintain discipline, which will probably lead to a loud and highly embarassing scene as she drags her daughter screaming from the post office.

There is a long pause. Everybody is watching with bated breath.

Mother says, "Well...alright then."

MDH and I look at each other in horror. We turn and see a whole row of old ladies standing behind us, shaking their heads like sad puppets. All of us watch desparingly as the family walks out the door, Little Girl holding her doll like a trophy. The spoils of war.

Child 1, Parent 0.

Flickr pictures

My Flickr pictures haven't been showing up on my website for a few days now. Anybody got any ideas on what's going on?

With eagle's eyes

1st of September marks Teachers' Day in Singapore, the celebration of which (oddly enough) involves the teacher's themselves putting up items and sketches for the entertainment of the school. I thought I would take this opportunity to write about the very first teacher who made an impact on me.

Mrs T was my form teacher during my 1st year at Primary school - which meant that she taught us English, Maths and 'Moral Education' (more on this in another post).

I remember she was very slim and had reading glasses that hung round her neck attached to a gold chain when she wasn't using them. I was particularly impressed by this gold chain because I'd never seen anyone using it before and it struck me as a very good idea. Additionally, it reminded me of one of Sherlock Holmes's tales in which the hero found a pince-nez - and for a very long time, until I discovered what a pince-nez truly was, I would think of Mrs T and her reading glasses.

She had a calm, steady voice that had a roughness around the edges that made me think of crumpling paper, or the trees bending in the wind. She always spoke quietly, so that we would have to be quiet in order to listen, and she never raised her voice because she never had to.

She was always quick to praise any of her students for any number of good things but always careful not to praise one student above another one. "Naomi got 100% in the test and Minghui has made the most improvement" or "Melanie, your uniform is so nice and neat today" or "I see that Xiaomin has a book where she jots down her homework - what a good idea!" or "I saw Noelle sharing her snacks at recess; that was very kind".

This is how I began to learn through observation. Mrs T did not just look at her students. She noticed them, the little things. As young girls of six and seven, we weren't little angels, but our characters were still soft, and she knew that everything she said would make an impression. Perhaps this is why she was so careful not to be harsh with us, perhaps this was why she chose to show us how to see good in other people, so that we would learn from each other what is good, worthy and admirable.

Once she said, 'Look around you, with bright eyes, with eagle's eyes'.

I looked at my classmates and I would see...this girl was tall and she always looked after the ones who were smaller than her...that girl was rich and she was always sharing her colour pencils...this girl was hardworking even though she wasn't very clever...that girl had a hand-me-down uniform but she was always the neatest...

When I got older, I realised that taking notice of people helped me to understand them more. At secondary school, it was seen as a particular gift of mine to understand the people around me, see their strengths and their weaknesses. Because of this, I found it easy to get along with all my classmates, in a classroom divided into factions by teenage angst and PMS, something that my teachers noticed. I was particularly good at motivating people - which was great fun, because I occasionally goaded my class into all sorts of mischief (which, I would like to add, we never got into trouble for, because I would know what each teacher could tolerate).

As a doctor, the power to understand people and to learn from them through observation is absolutely necessary. I am good at establishing a rapport with my patients - it is one of my strengths. My patients often find it very difficult to explain to me what is happening to them, or they try to hide what really happened (especially if they've been abused) instead the body displays subtle clues that I must not miss.

Thanks to Mrs T, I look at the world with eagle's eyes.

Happy Teachers' Day.