Too much information

Part of being a doctor is knowing how to manage sensitive information. Building a good rapport with a patient and being observant are skills that help me to learn intimate details of that patient's lifestyle. I have to ask questions about sexual habits, social issues, bowel movements - the sort of things that aren't mentioned in polite society.

It's a very odd feeling, having all this intimate knowledge of a complete stranger. Oftentimes I wish I didn't know so much.

For example, I recently saw a young man who was (one might say politely) rather on the hefty side. He had some pain in his upper abdomen, worsening over the last few days and it was getting quite unbearable.

So I examine him and I find that the pain is coming from a rather odorous patch of skin over his tummy that had become very ulcerated and infected.

And the source of infection was a cheese sandwich.

Yes. This would be a good moment for you all to run and get a basin or a bag of some sorts.

This young gentleman had been enjoying an afternoon snack but had dropped it, half eaten, somewhere on his person and he was so, er, hefty that it had gotten lost somewhere in the folds. Don't ask me why he left it there. Maybe he was saving it for later? I don't know. I don't really want to know.

However, I do know the following:

1. Objects have been lost in the rolls of fat on his person. He has really let himself go. I wonder what other hidden treasures lie in the depths.

2. This man has not washed himself for a long time. Judging from the state of the cheese sandwich, I would say at least a week.

3. This man eats his meals in the buff. *shudder*

4. This man often drops food on the floor of his home, but doesn't bother to look for it to pick it up again. His living arrangements are probably less than desirable.

5. This man probably does not have a job. Or any friends. Or anything that involves getting himself out of the house.

6. This man must be very lonely.

7. This man hates his body so much that he can't even look at it long enough to find out why his stomach was hurting. He had to get someone else to look for him.

You see what I mean? Too much information!!

Hooray

So I passed the exams and now I am qualified to save the lives of little people aged 0-15. This is a very good thing.

Part of the course was aimed at drumming lifesaving skills into our thick skulls so that dealing with paediatric emergencies becomes more of a brain-stem reflex. This means that I no longer have to think and ponder on how to manage a very sickly child. I go automatic - no thinking, just doing. Saves time.

The other part of the course involved memorising random bits of information.

For example, I now know that when a child is being born prematurely and there isn't a baby incubator within reach, one of the first things to do to it is to keep the child warm and moist by putting it in a plastic bag.

Not just any plastic bag, okay, a food grade bag suitable for microwaving and roasting.

Obviously it's not traumatising enough to have a baby prematurely, but one also has to watch as the doctor chucks the child unceremoniously into a plastic microwavable bag.

I also now know that if a child is choking in a public place and I can't relieve the obstruction to their air passages with simple measures, the best thing to do is stab them in the neck with something pointy and then shove an emptied biro (ie. ball point pen) into the hole to act as a temporary airway.

Exciting, huh?

I hope I never have to do it.

Concentration

It's really difficult to concentrate on this course. I mean, when I'm trying to resuscitate a plastic mannequin that is rapidly deteriorating despite my best efforts, the last thing I need is for a flock of emus to run past the window just as I'm trying to gather my wits about me.

This course is tough, I tell you. 3 days of intensive learning, and I have to pass 4 exams at the end of it. Stress, man. If I don't pass, it's £500 down the drain.

Okay, back to studying.

Directions

"So, straight on down this road, past the flamingoes, turn left after the rhinos. It's on the right, opposite the llamas. If you've reached the ape sanctuary, you've gone too far."

The fog lay thickly over the grounds, and I shivered in the cold as I trudged up the hill. I heard the gibbons crying out in the distance, and a pair of wallabies bounded towards the edge of their fence and studied my movements with curiosity, ears twitching. I caught a glimpse of the white rhino peering out from within the heated depths of his accomodation. The llamas turned their heads as I passed, chewing methodically, the hippos yawned in disdain, and over the tops of the trees in the distance, the heads of giraffes poked through the foliage.

The paediatric life support course is being held at a mansion in the middle of the local zoo. I arrived too late and missed the choo-choo train that shuttles from the main entrance to the mansion, so I had to walk there by myself - a good 20 minutes brisk walk, uphill.

I wouldn't mind having to walk through there every morning.

Fool

I have an ulcer on my tongue. And one on the inside of my left cheek. The deadly spawn of stress and dehydration.

Now when I talk, I sound like the deadly spawn of Donald Duck and a Sylvester Stallone, lisping through my teeth, omitting consonants or changing them to 'W's.

"Hewwo. Howwah you feewing today?"

"Tay sthome deep bwefs in pweez."

Sound like a fool.

One of my patients actually tried to sniff my breath, you know, to see if I was inebriated. I feel very sorry for her, because I hadn't drunk any water for 6 hours, so my breath was highly poisonous at that stage.

Heh heh heh.

Night in

Cloudless night. Frozen stars.

Cold nose. Icy hands. Frigid toes.

Home. Lasagne. Melted cheese.

Garlic bread. Crunchy golden crust.

Hot chocolate. With cream. And chocolate shavings.

Raspberry and apple juice. Sweet and tart.

Rented movie ('Kung Fu Hustle'?! MDH's choice, of course. I wanted to watch 'The Eternal Sunshine of the Spotless Mind'.). Hilarious and idiotic.

Giggles on the sofa under a fleecy blanket. Warm and snuggly.

Goodnight.

Ice-hearted

This morning, there was a nip in the air as I walked to work. The pavement glittered silver, the sun peeped through the bare, crystallised branches of trees, the fallen leaves on the ground were edged with white.

There I am, surrounded in the beautiful works of Jack Frost, and all I could think of was:

"Wow. I hope all the old people stay at home today."

I think I'm dead inside!

*8 hours later*

So the old people didn't stay at home today - within my first hour at work, I'd seen five elderly folk who'd wandered outside their homes, slipped on the sparkling icy streets, and wound up in front of me with broken hips.

15 days

I can't believe that I'm going to be back in Singapore in 15 days time. It's unbelievable!

First, I have to get through the next 4 days of 10 hour shifts, then an intensive 3 day Paediatric Life Support course and examination, followed by a week of overnight shifts.

When will I find time to pack?! Or buy Christmas presents?! Or watch 'Harry Potter and The Goblet of Fire'?! So much to do, so little time!

*maniacal laughter*

Crunching numbers

It takes:

- 1 person to trip up a blind man and dislocate his elbow, 3 doctors to relocate it.

- 1 lighted cigarette to cause a fire , 4 skin graft operations to restore the smoker's appearance.

- 10 seconds to mug an elderly lady and break her hip, 3 months for her to walk again.

- 4 pints of lager to cause a road traffic accident, 6 pints of blood to resuscitate the driver of the other vehicle.

- 1 instance of unprotected sex, 1 lifetime of pelvic pain and subfertility.

Unfortunate

It's really unfortunate when a person is just standing around, minding his own business when suddenly,

1. His hand comes into contact with a broken car window and he gets bits of glass and cuts and scrapes all over it. Don't know how the car window got there or how his hand happened to be in it, really.

2. Another person's fist appears in the middle of the pavement and he happens to run into it and give himself a black eye. That's how it happened!

3. He becomes incredibly drunk and falls over and can't get up. Without having had any alcohol that day, I swear!

4. He finds some pills and decides to eat them and they make him hallucinate. Never had them before, didn't know what they were, I just found them on the ground in the park.

5. He falls off his motorbike and a pair of ladies underwear is in his jeans pocket and quick get rid of it before my girlfriend comes, it was there when I put them on this morning, I don't know whose they are.

Twilight shift again

6pm to 2am is the busiest shift.

Everyone comes in after being in the office or at school all day long. The GP surgeries are closed, so all those who can't wait until the morning will pop round to the A&E.

I have a raging headache.

I hope it's quiet today.

Retail Therapy

Retail Therapy
Originally uploaded by Sunshine follows me.

I don't often go shopping unless I have something specific in mind that I want to buy. Window shopping gives me a headache (probably overstimulation), and unless I'm actively looking for something that I want or need, I hardly ever see anything that I like.

Today, however, I wanted to buy some blank books and maybe a new spring/fall casual jacket (considering that I have been looking for a new jacket for about 4 years, I wasn't getting my hopes up). So I wandered around the shops for about 3 hours and came back with:

1. A jean jacket with brassy buttons. Yay for me!!! When I wear it, I look sweet but also HAWT. Absolutely spicy apple pie, that's me. It has a pleated bit at the back so that if I ever decide to get breast implants or if I go for a binge-trip, I'll be able to wear this jacket and still look delicious.

2. A present for MDH (the season one DVD of 'Red Dwarf'. He's gonna be so pleased.)

3. A purple fabric bound blank book with pink felt birds on it. I plan to turn this into my sister's present. Not sure how yet (any bright ideas??). But I have a Good Feeling about it. Plus it's so beautiful!

4. A lightweight, spiral bound, plastic covered, travel journal.

5. A spiral bound pocket notebook with flowers scrawled on it in an Artistic Fashion (this was my one indulgence today - buying something just because it was pretty.)

This all makes me very happy. I get very happy when I've had a successful shopping trip. Yes, I know I spent 3 hours only buying 5 items. I am a very restrained shopper. Just to give you an idea about how restrained I am, here's what I did not buy:

1. A beautiful dark red Coast belted macintosh. It was called Anushka and it was 30% off and I stood in front of it stroking the rough tweed fabric but I dared not try it on because I already have a three-quarter length coat.

2. A soft calfskin gilet with silky faux fur trimmings from Warehouse. It was decadence with a devilish edge and when I put it on I felt like Lara Croft but it was £65 and in the end, a gilet is just a fancy name for a vest and besides, it was dry-clean only.

3. A knit scarf with horizontal stripes in autumnal colours so vivid you could smell the cinnamon and orange and the roasting apples. I put it on, took it off, put it on, put it down, picked it up, put it on again, paraded in front of the mirrors, took it off, walked around the shop holding it, and the end I had to leave because it was too much exercise.

4. The special edition box set of 'Back to The Future'. It was a choice between that and 'Red Dwarf'. 'Red Dwarf' won because it was the last one in the shop, and I didn't know if I would ever find another copy again. Also, 'Red Dwarf' did not have a uglified cover embossed with a scratched and dented DeLorean.

5.The City of Beasts by Isabel Allende (I may get it off Amazon instead).

Sunset from my window
Originally uploaded by Sunshine follows me.

To celebrate my accomplishments, I got myself a nice festive red cup of Starbucks minty hot chocolate, and sipped it slowly whilst reading through some study materials (I've got some pre-course homework to complete by next weekend).

When I got home, looked out the window and this beautiful pink and red sunset started singing to me - almost fell out of the window trying to get a picture of it to show MDH (later he's asleep at the moment - working the overnight shifts, see).

I'm gonna go marinate some beef steaks now...I can't wait to see MDH's face when I give him his new DVD! Whee!

Ideas, anyone?

My sister is turning 21 soon, and I want to get her something special.

Something grown up that says "Hey, you're 21 now! Welcome to the big league!" but not so womanly so that it still says "Hey little girl, this is from your big sister!".

Anyone have any suggestions? Anyone got a birthday present that was so amazing that they still look at it and it makes them feel happy?

I'm ruling out gold jewellery, by the way - that's probably my parent's domain and they've got first dibs on buying the commerative bling (they've earned the right).

I don't actually remember much about my 21st birthday - it was still a big deal, had the party and all that - but I'd just come out of a serious long-distance relationship, so it was the first time I had seen my ex-boyfriend since we had broken up a month previously. I think I spent my 21st birthday pretending to be shiny and happy whilst everyone hugged me and kissed me and looked misty-eyed and said I looked so grown up.

I didn't love any of the presents I received that year. I have bad memories of my 21st year. It was a bad year.

Alternative medicine

People should not try to mix conventional medicine with alternative medicine.

If you see a medical doctor, follow the doctor's advice.

If you see a bioresonance healer, follow their herbal remedies.

Do not see the bioresonance healer, and then come to the hospital and demand to be treated with pharmaceutical drugs! It does not work that way.

Good Day

Today:

1. An old lady held my hand and told me that I had warm hands and a healing touch. She was smiling, and the light behind the bed shone through her hair, so it glowed like a silvery halo. She said that I had put my hands on her stomach and taken away her pain. Actually, I was examining her stomach, whilst the nurse was busy giving her a little bit of morphine.

2. The drunk man said that I was beautiful. Even though I was busy jabbing him with a needle at the time. The power of beer goggles (or beer armour, in his case; he didn't even feel the needle going in) truly baffles me.

3. The 2 year old with the bump on the head said 'Tank you doctor' and then hugged my leg. On the way out the door, he waved and then blew me a kiss. His mother was surprised - he's usually shy around strangers. I guess he must have liked it that I could sing 'Bob the Builder', 'Postman Pat' and whistle the 'Wallace and Gromit' theme tune. I didn't even have to bribe him with stickers to make him sit still (but he did get one in the end for being such a good boy).

4. I sat in silence for 5 minutes next to the angry teenager who refused to speak to anyone, and in the end she told me why she had decided to cut her wrists. Later on, she said that she realised that talking would be the only way she could get rid of me. Haha. I win in the battle of wits once again!

5. I put a cannula into the arm of an oncology patient (end-stage lung cancer) and was successful in my first attempt. He cried because he was so relieved - usually it takes people three or four attempts to get one in, and he usually ends up with massive painful bruises. I told him that I was the queen of cannulas. He laughed.

It has been a good day.

Bad Day

Today I had to:

1. Examine the cheesiest scrotum in the world. How do people let themselves go like that? This guy actually waited a whole week before he decided that it was highly inconvenient to have to change underwear three times a day. There was pus was everywhere. It was horrible. And it smelt bad. I almost threw up on him.

2. Wipe vomit off my stethescope and my hands. Thank God for my quick reflexes - I managed to duck out of the way just in time. Otherwise I would be washing half digested peas and carrots out of my face and hair.

3. Hold down a screaming child with one hand whilst using the other one to twist her dislocated elbow back into place. She will never trust another doctor ever again. I have scarred this one for life.

4. Put a needle into an elderly man who was so delirious with fever that he had gone back to the darkest times in his life. He grabbed my hands and screamed at me to rescue him from the camps and take the messages to 'Mr Smithson' and then he gibbered in Jewish and German. He had a string of numbers tattooed on his forearm. Then I put the needle in him, he called me a Nazi and a traitor, then lunged for my throat before passing out from the sedative I gave him. Fun times.

5. Tell a man that he shouldn't drive until he is free from epileptic fits for at least 1 year. He drives buses for a living. And I guess, well...that he can't be a bus driver anymore. It's horrible to see a grown man cry.

It has not been a good day.

Conversation

We are sitting together on our bed. It's a bright morning, and we are both recovering from a heavy weekend of long shifts so we've decided to take our time getting up. I am curled into a ball, face half-buried in my pillow, and MDH is sitting up, looking out of the window.

MDH: I was thinking yesterday that it would be really wonderful to have a baby. I think I will be ready for one soon.

TSCD: (suddenly wide awake) What? What?

MDH: Yes. I was just thinking.

TSCD: What? What? (gesticulates wildly)

MDH: I've seen how you look at children. I've seen your face when you read about other people's children. I know when you're thinking about it. I've seen that look.

TSCD: What what what d'ya mean? What look? There's no look! I mean, so what? I mean, that's not the point!

MDH: Anyway, I just thought, yeah, that it would be okay. I'm not saying I want children right now, but the idea doesn't upset me, and if we decided to have kids soon, well, it would be okay.

TSCD: How soon is soon?

MDH: One and a half, maybe two years? Hopefully we'd have steady jobs by then...

TSCD: And a house.

MDH: And a house.

TSCD: (silence)

MDH: I just wanted you to know that if it would be okay with me. I'd be very happy. Really happy.

TSCD: Really?

MDH: Really.

TSCD: (silence)

Remember, remember

This weekend, most of the country spent every evening staring at the night, watching the pyrotechnics as they whizzed and fizzed and burst into crackling showers of twinkling and glittering stars. Most households clubbed together and set off fireworks from their backyards, with their little ones skipping around the bonfires waving sparklers that leave trails of bluewhite smoke and holding out roman candles that belch flames in kaleidescopic colours.

Some of the country, however, weren't enjoying the Guy Fawkes shenanigans quite so much. Some of the country spent the weekend shivering away in an A&E department with broken central heating (I pity the folk who had to tolerate my icy touch). Some of the country spent the weekend worrying over the man hit by a rogue rocket, the woman singed when Catherine escaped her wheel, the child who had fallen into the bonfire.

Burn injuries are horrific, painful, disfiguring. The body retains heat even after the source of the burn has been removed, so the flesh continues to cook underneath blistered skin and it can take a long time to cool the body down. Even now, with new techniques of skin grafting and the restoration of plastic surgery, the process of recovery is still long and terrible.

I looked at my patient's small hands, skinless and blackened with soot and at the reddened eyes peeking out at me from under a mass of bandages, and I listened to her gurgling breath and weak whimpering, and I watched the green blips on the monitor, the saline dripping into tubes, the pale faces of her parents and I thought about the many times I have heard people bemoan the fact that firecrackers were banned in Singapore and rant about the loss of heritage and tradition and fun. And my heart ached in my chest to see the result of fun without restraints, without boundaries, without thoughts of safety.

As I walked home later on, my path was lit by a myriad of explosions and I stood still and watched, breathless, as lights streaked and danced across the chalky sky, reflected in the windows of houses, in puddles of water, in the eyes of children who shrieked with laughter and clapped their hands.

Is it worth it? Is it worth it?

Not for some.

It's not a good sign...

...when you get to work and you think it is Monday, but it is actually Saturday. It is also a bad sign when it takes you five hours to figure out that you've been writing the wrong dates and times on everything!

I wonder if my patients would be disturbed to know that they are being treated by a doctor who doesn't even know what day of the week it is.

9 hours later:

Sunday afternoons, especially rainy Sunday afternoons, should be reserved for lounging around at home, wearing loose clothing and snuggling under the duvet covers with a nice book and a hot drink.

They should NOT be for waiting around in an uncomfortable, loud A&E department! Why come into A&E? Get some sleep and then see the GP on Monday! That way you get a decent rest and a day off work!

Mortal trappings

I sometimes get the feeling that my real self is trapped within my skin, weighted down by my bones and occasionally, I get an incredible burning in my chest, as if part of myself is screaming to be freed. I have an urge to scream, as if screaming would release my soul from this vessel and let it fly away.

I've noticed that this occurs soon after I witness a death or when I come into contact with somebody who is probably nearing the last moments of their life. I look into their tortured eyes and I see fear, and I know that their soul is both screaming to be released from their wretched body and begging me to help them to stay.

Then, when their heart stops, and we rush to resuscitate them, I look into their eyes again, and those eyes that were once filled with anguish now look like glass marbles. And I know their essence has gone and I am standing beside something that is no longer the bearer of a soul, but an empty shell. It's like looking at a glass carafe after the wine has been poured out. It's like looking at a candle after the flame has been blown out.

And I feel cold. And I am suddenly aware that whatever it is that is me and myself, is something more than this flesh and this blood. And this body is just a vehicle.

Soup's on

Tomato soup overlooking the bay
Originally uploaded by Sunshine follows me.

It's wonderful, on a chilly afternoon, to tuck into a huge steaming bowl of thick and creamy soup.

Whilst on holiday last week, we stopped by for lunch at a beachside cafe and they served up this lovely, rich, tangy tomato and carrot soup, laced with cream and topped with a sprinkling of basil. It was a sunny afternoon, but there was a touch of autumn chill in the air that made us keep our jackets on, and this soup really warmed us up on the inside.

MDH liked it so much that I decided to try making it at home yesterday.

So I got together a pound and a half of tomatoes, two carrots, an onion, a potato and a clove of garlic. After finely chopping up all the root veggies and crushing the garlic, I heated some olive oil in a pan and began softening the onion in the oil, sprinkling it with half a teaspoon of sugar.

After the onions had been caramelising for about five minutes, I added the chopped carrot and potatoes and covered the pan, cooking it over a low heat for ten minutes without browning the veggies.

Then I stirred in the garlic and tomatoes, added 1 teaspoon of tomato puree, about half a pint of chicken stock, and a pinch of basil and oregano. Oh yes, and just some lemon juice to give it a bit of kick. I let them all simmer for about 45 minutes, making sure that there was enough liquid in the pot (I've had the unfortunate incident of burning soup in the past!).

When the vegetables were all sufficiently tender, I brought out my handheld blender and whizzed it through the pot until it was all smooth, and then seasoned it with loads of pepper and a teensy amount of salt. Before I got the blender, I used to press all my soups through a sieve to take out all the pips and bits of skin, but it was such a hassle.

I love making soups. It's so easy and it freezes well, which means that I can make huge batches of it in advance. I am anticipating a long week of heavy shifts at work, and MDH is working 3 weeks in a row with no weekend breaks, so neither of us are going to be in a fit state to cook.

And when MDH tramps through the door, shivering with cold, I like to watch his eyes light up when I bring him a hot bowl of flavoursome soup.

Days to myself

Autumn on the High Street
Originally uploaded by Sunshine follows me.

It's nice to have a day to myself. MDH is at work, and I'm at home alone, catching up on paperwork and household chores.

This morning, after doing some washing, I spent the rest of the hours making a huge batch of tomato soup, which is now bubbling away on the stove.

Later on, I'll probably wander down to the centre of town and visit the shops. I really want to get a nice blank book to use as a travel journal - with stiff pages that won't crumple easily and a hardcover that has got a tactile surface that makes you want to pick it up again and again.

It's also time I bought MDH a present, and I would like to get him a Neil Gaiman novel. American Gods, perhaps. I think it'd be the sort of book he'd enjoy, seeing as he likes gothic fantasy novels like the Gormenghast trilogy.

Or perhaps, the latest Iain M Bank's novel. (Then I can read it after he's done! Woohoo!) We shall see.

Red falling leaves
Originally uploaded by Sunshine follows me.

Autumn is a great season. The air is pleasantly cool and the wind whips through the streets, stirring the falling leaves into a swirling dance.

When the sun is out, it's a joy to sit on a bench on the high street, watching red-cheeked people scuttle by whilst sipping on a warm cup of coffee and perusing a new novel.

Leaves in brilliant shades of red will flutter down and land on my lap, migratory birds roost under the eaves of buildings and call to each other, pampered pooches scamper alongside their owners wearing little plaid coats.

Plus, I get to wear fun stuff and strut down the street, feeling cosy in a light fleecy scarf with tassels, a macintosh of faded gold, knee high boots. It's all about accessories, baby.

Sometimes, I think that the biggest draw to staying in a temperate climate is getting to wear the great outfits.

Seasons change

Summer from my window
Originally uploaded by Sunshine follows me.

It was a really tough day in the department yesterday. It was so crowded that we had people sitting out in the corridor on plastic chairs, the nurses had to call in reinforcements, we had to beg for some locum doctors...it was nightmarish.

I had a wonderful time on holiday, but it was rather horrid having to come home and start work straightaway. And there's two weeks worth of laundry waiting for me.

Autumn from my window
Originally uploaded by Sunshine follows me.

This morning, I looked out of my window and realised that autumn had finally arrived.

The majestic oak that stands in front of my apartment is decorated with the autumnal colours of gold and brown. Only a few weeks ago, it was splendid with green leaves gilded by sunlight.

It's amazing to me how living things are always changing, oh so fast, so quickly, speeding up every minute and I feel caught up in the frenetic pace of it. Or rather, I feel like I'm being dragged along.

Or maybe I need a longer holiday.