Finished

So, I've finished medical school. No longer a medical student, not yet a doctor, I am enjoying the blissful in-between stage where I don't know how to introduce myself but at least I've finished all of my assessments.

Our esteemed School of Medicine has lost a few fans this week. Our 6-weekly assessment forms which we are not allowed to touch or see, suddenly became our responsibility on the last Friday when our administrators decided it was our job to make sure they were all handed in ... by Monday. So they kindly provided 60-something students with a list of their incomplete assessments and told them to chase the forms up or else their graduation would be delayed. Well handled.

At least the week-long celebration known as "Grad Week" is run by students who want nothing more than to see their classmates / colleagues having a great time. Starting with a champagne breakfast this Thursday and finishing with a ball after the graduation ceremony next Thursday, the week is packed with various activities to entertain the new graduates and their families.

I'm most excited about seeing the printed version of the Yearbook which I've spent the year putting together with the help of an insanely talented classmate. It was a well-timed coincidence that the printer demanded an electronic copy during the last week of med school, because it's been a brilliant excuse to avoid schoolwork.

Luckily, I enjoy finishing projects slightly more than I enjoy procrastinating. And med school has been one hell of a project.

Needles

The only vein the anaesthetist could find to cannulate was on the patient's inner wrist - a location that can be quite painful.

From where I stood on the other side of the bed, I noted that the patient had a small tattoo on their arm and said cheerfully, "well you're obviously not afraid of needles in your arm!"

The patient just looked at me and then turned back to the anaesthetist, who deftly threaded the cannula into the small vein and undid the torniquet.

And that's when I saw the track marks.

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Lolly Drop

When I was much, much younger, the highlight of the local picnic races was always the "lolly drop". It was far more exciting than the races themselves, or even the horse high jump.

A local pilot would fly over the paddock in a light plane and release hundreds of lollies as us kids waited anxiously for permission to run out and collect them. When those in charge decided we were no longer in danger of being killed by Minties falling from 3,000 feet, we would all sprint out and fill our hands, pockets and jumpers with lollies, eating them as we went. Nobody ever missed out and missed lollies could be found in the paddock up to a year later.

And then as the years passed, the picnic races faded away and the lolly drop became just a fond memory.

Until a few years ago, it was reinstated at the Keith Show. As sponsorship has increased (mostly from locals who remember the glory days of the picnic races), the lolly drop has once again become the highlight of the day for local kids ... and their parents.

Antigonish

Yesterday, upon the stair,
I met a man who wasn't there
He wasn't there again today
I wish, I wish he'd go away ...

Wheh I came home last night at three
The man was waiting there for me
But when I looked around the hall
I couldn't see him there at all!
Go away, go away, don't you come back any more!
Go away, go away, and please don't slam the door ... (slam!)

Last night I saw upon the stair
A little man who wasn't there
He wasn't there again today
Oh, how I wish he'd go away

Not sure why, but part of this poem by Hughes Mearns popped into my head today.

Uh-pinion

Comment on a news article about Australia's most admired women.

The list was compiled by surveying about 1200 Australian females, and included the likes of model Miranda Kerr, Olympian Cathy Freeman, actress Cate Blanchett, Fred Hollows Foundation director Gabi Hollows and our PM Julia Gillard.

I'm sure they all have very admirable qualities and I'm sure even the broad-accented Gillard knows how to use the word "use".

Time to find a new role model, Maria!

Zero

I can't pretend to be the greatest student in the world.

That said, when a fortune teller in Singapore told me I would top the class in October, I allowed myself to become quietly hopeful. As all my classmates started getting their grades for our first big assignment, I kept checking and re-checking the student system, waiting for my grade to appear.

And yesterday, it finally happened - a notification saying "New Grade - Evidence Based Medicine".

I hurriedly opened the link, to see ...

Zero! Reviewed by the Section Instructor and everything, so it couldn't be a mistake.

I quickly looked for an email telling me to pack my bags and find a different career, but there was nothing.

In a panic, I called the course administration unit to ask what to do about it.

"Oh, just ignore that" was the breezy instruction, "I accidentally put in a grade but yours isn't marked yet. I couldn't leave it blank so I put a 0".

Oh. Thanks.

Abbreviations

BPAD = Bipolar Affective Disorder

BPSD = Behavioural Problems Secondary to Dementia

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Orientation to Time

Me: "What year is it?"

Patient: "Now what do you mean by that? What year is it now, or what year is it in October?"

Me: "Um ... what year is it now?"

Patient: "September"

I give her a point for knowing the month.

Me: "And what year is it?"

Patient: "Not a year I should be living in"

Me: "Do you know what day of the week it is?"

Patient: "Well it should be Sunday. But it's not. It's Tuesday"

Me: "Very good"

Subjective Cuteness

My dog Sprite is the cutest animal in the whole wide world. That has always been my firm belief.

But then I tried taking photos of our two dogs on the weekend.  My sister's dog 'Doggers' looks exactly the same in photos and real life. Sprite, not so much. Her photos do not look cute at all.

Doggers looks just like this in real life

Sprite, I believe, looks much cuter in real life

And then I had the shocking realisation - what if she's not as cute as I think she is?

And then another thought - it doesn't matter.

A Banana and an Orange

The "Frontal Assessment Battery" (FAB) is supposed to be an objective measure of the functioning of the frontal lobes of one's brain. The frontal lobes deteriorate in certain types of dementia and people become disinhibited, lose mental flexibility and are less able to conceptualise material.

I did the FAB test on someone who'd supposedly had a bifrontal lobectomy (both frontal lobes removed) and they scored points, which says something about either:

1. The brain's ability to compensate

2. The surgeon's ability to remove parts of the brain, or

3. The FAB test itself

I'm not a huge fan of the test itself. Some of the questions are quite difficult, because it's not clear what you are being asked. Take for example, question 1.

"In what way are they alike?"

1. A banana and an orange

2. A table and a chair

3. A tulip, a rose and a daisy

Try answering them now.

There is only one correct answer for each.

1. The only correct answer is "they are both fruit". "They both have peel" is a partial failure and you don't get a point. "They're nothing alike, what a stupid question!" will also get you 0 points.

2. A table and a chair are both furniture. Yes, they "both have legs" and technically they are both "optional", but only "furniture" will get you the mark.

3. A tulip, a rose and a daisy might be "strange bedfellows" to an avid gardener, but unless you say that they are all flowers you will lose a mark.

Not an impossible test, but hard work for patient and examiner. I've included the link above if you feel like testing someone you know ...

Circle of Life

When I was younger we used to have bushes around our house that had very pretty purple and white daisy-like flowers. Unfortunately the garden snails loved them, and whilst they didn't do much damage to the plants, it was really annoying to have an enormous snail breeding-ground right in front of the house.

So we acquired some ducks which, in case you didn't know, are snail-eating champions.

Unfortunately duck eggs are a funny blue colour and nobody ate them because we also had perfectly normal chook eggs to eat.

So we made cakes to use up the duck eggs.

And then we got sick of the ducks because they're messy and awful, so we sold them all. Nobody wanted a whole flock of ducks, but our Vietnamese neighbours bought a pair every week until they were all gone.

And then we pulled up all the plants.

And that, kids, is the circle of life.

Busting

Patient on Psychogeriatric ward: "I couldn't piss before and now I'm fuken busting for a wee"

Correctly interpreted by a nurse as: "I've forgotten where the bathroom is"

Firefox Fail

Just in case you didn't know, I am not somebody you want to have around your computer. I can crash the uncrashable, freeze the unfreezable, download viruses from perfectly legitimate sites and uninstall programs without your permission. So it's helpful when computers give very specific reports of what has gone wrong - like this one from 5 minutes ago:

Home

Just past 6 o'clock on Saturday morning, Qantas flight QF82 touched down on the Adelaide runway.

I left home in May and now, four months, three continents, ten countries, several travelling partners and countless eye-opening experiences later, I am home at last. Right up until the last day I couldn't imagine my little adventure ending ... an outlook which resulted in much scrambling to pack, finish assignments and do last-minute souvenir shopping (none of which I completed successfully).

Somebody asked if I'd returned as a whole new person and no, I don't think so - I think I'm the same old person who's now seen a lot more things. A lot of things that I'd never hope to see again, but have opened my eyes a bit more to the world. 

It's a big place.

Transport in Cambodia #2

Some more of the transport options in Cambodia ... where a vehicle's capacity is only limited by how much freight or how many people you can physically load into it.

Riding in style in a "cyclo"

Honda Daelim, not the romiest family vehicle

A very full truck

The family bicycle

One full van

The pig truck

Choosing style over safety ... or something

Indian

My sister, with her brown eyes, dark hair and olive skin, is an ethnical puzzle to most people she meets. French waiters think she’s Spanish. My Japanese housemate was convinced she was Japanese. Customers at work think she might be Croatian, maybe Puerto Rican, possibly Italian, but never Australian.

My boyfriend’s parents are Khmer Cambodians, but everybody in Cambodia thinks he’s Chinese.

Me, I’m Australian. Nobody’s ever questioned it. 

And then I stepped into theatre in Phnom Penh and the surgeon paused operating on the cleft palate in front of him to declare that I looked Indian.

Maybe, I thought – with a cap and mask on, if you were too far away to see me properly. But no, my boyfriend revealed later that the surgeon had spent several minutes discussing the point with him the day before. He was actually convinced I was Indian.

Must have been my accent.

Ravi

Ravi the security guard is a cheerful young man. For 12 hours a day, 7 days a week he sits at the front of the apartment in his blue uniform. 

He makes $3/day working for the security company, who pick him up in a truck at the end of the day along with all the other guards in the neighbourhood. With his $3 he can buy a meal of noodles from a street-seller for 75c, so as long as he doesn’t buy a drink he may just come out on top. Unlike the night guard who wears civilian clothes and is allowed to sleep on the job, Ravi has $1 deducted from his pay if he is caught sleeping.

Still, he greets us with a smile and “arroon sous day” or “good morning” when we emerge at 7.30am. He always rushes to open the gate wide for us to pass through. If the tuk-tuk driver accidentally takes me past the apartment, he’ll run out and flag it down so I get home safely.

He makes friends with the little boy from down the road, who hangs out near the fence so they can listen to the radio together. Sometimes we buy him dinner and he thanks us profusely, even though it’s the same 75c noodles he’d buy for himself. 

He's got another job lined up closer to his home town, where he'll make a little bit more money and might be able to save for the future. All the best, Ravi!

Bory

On my first day of placement, my boyfriend’s parents kindly organised a tuk-tuk driver for me. After “auditioning” several drivers (making them all compete for the best price), they finally settled on Bory. For $6/day Bory would pick me up at 7.30am, take me to the hospital, and then pick me up again at lunchtime. If needed he’d take me back in the afternoon, or I could have him take me to the market. For an extra charge we could go further to the main tourist attractions.

For the entire 6 weeks, Bory was never late, and he never stopped smiling. 

He wouldn’t let me pay him at the end of the first week, preferring to wait and get the month’s worth as a lump sum. I imagine he dreamed all month about the things he could buy for $120 in Phnom Penh.

He frequently got lost, but he always quite happily stopped for directions and never charged extra for the scenic route. In his broken English he would explain how he got confused, and then laugh about it.

I’m not convinced Bory is a real tuk-tuk driver. When he wasn’t driving me around, he’d hang out with our security guard and his tuk-tuk driver friends. Other tuk-tuk drivers would yell out “tuk-TUK!!” to anybody who walks past, hoping for business. When people walked past Bory, he did nothing. My boyfriend’s parents actually had to call him over to discuss business that first day.

Maybe he’s a secret millionaire. 

Photos

Today was my last day of Paediatrics in Cambodia. Yesterday I brought my camera in and took loads of photos, including a few of the kids in the HIV ward. I printed them out this morning and handed them to the parents, who proudly showed them to all the other parents in the ward. 

Soon enough, all the parents were gathering up their children and demanding that I also take their photos.

Luckily there were only 12 families, but in the end I made three trips to the photo shop and spend many thousands of riel (almost $3) printing them all out. It was great seeing the kids’ smiles and how much the families appreciated the photos - many poor families don't have a camera, so photos are a rarity.

Most excited to receive her photo was the cleaning lady I'd snapped on the way to the printers. She was happy that I'd even taken her picture, and then when I printed it out and put it in her pocket as she was hanging out the linen she almost cried. She looks like she's scrubbed in for operating theatre, doesn't she?

Pink Stethoscope

The pink stethoscope teaching a first-year nursing student what pulmonary TB sounds like.

Around the Hospital

A few pics from around the hospital ...

Group physiotherapy session

Stepping through the hospital doors

The indoor playground. Those kids spotted the barrang (me) and started yelling "hello!" while I was still miles away. So cute!

Random vans in the hospital car park

Not official hospital transport - kids on a sack truck

The HIV ward

Weighing scales in the triage area ... and a Christmas outfit!

Happy Fathers Day

Happy Fathers Day to all the Dads out there!

Especially mine because he's the best.

Electrical Safety

"What leftover electrical cable?"

Powerline, Phnom Penh

Iced Coffee

I am such a master of the Cambodian language (Khmer) that I can now order iced coffee for my boyfriend and myself. "Pbee cafe d-doh gore d-goh" (where the oh is a sharp 'o' as in 'hot', sorry but proper phonetic spelling confuses me). It translates to two coffees with milk and ice. Unfortunately I mastered this at exactly the same time as the girl at the hospital cafeteria memorised our drink order, and now she doesn't even let me finish.

So in Kep this weekend, I saw a street vendor and seized the chance to prove myself. I knew it was all going to come down to my amazing Khmer when the girl greeted me with "hello sir", and I announced that I would like "pbee cafe d-doh gore d-goh". Seeing that I was alone, her male assistant held up one finger and asked if I would like "pbee" (two) or, holding up two fingers, "pbee" (two). I held up two fingers and said that I would like pbee. Two.

Then she made an iced coffee without milk and I quickly cut in and said "d-doh gore" (milk). In English she replied "you are getting a different one. With milk" and handed the black coffee to someone else.

Then she made me two iced coffees without milk and got all annoyed when I asked her to put milk in them.

Back to the hospital cafeteria for me.

Choeung Ek

Choeung Ek ... a place where brightly coloured butterflies dance in the trees, hens raise broods of cute chickens, locals fish with nets in the large dyke ... and thousands of men, women and children were murdered and buried in mass graves, victims of Pol Pot's Khmer Rouge. 

It's hard to believe that this "autogenocidal" horror occurred not 40 years ago. Harder still to believe that such a beautiful place as Choeung Ek could have been the site of so many executions where soldiers killed their fellow Cambodians by striking them with ox-cart handles, pickaxes, bamboo sticks and other sturdy pieces of equipment, so as to save on ammunition. And almost impossible to believe that  the Khmer Rouge wiped out almost a quarter of Cambodia's population through starvation, torture and mass-murder and still held a seat on the UN for another 15 years. 

Oh, world. You are so messed up.

Broken bones

Sign in the Killing Fields

Some of the thousands of skulls on display

Subconjunctival Haemorrhage

Little kid has a massive coughing fit and the result is ...

Subconjunctival haemorrhage. Apologies for the poor quality photo.

Pupils equal and reactive, no visual disturbances or abnormal neurological signs. And he seemed fine about it, although the parents were a bit freaked out.

Reanimation Room

Sounds like an important section of Frankenstein's lab ... turns out to be a fairly low-tech room where dengue patients are kept under close observation. Disappointing.

Cambodian Food #2

Another little selection ...

Food van with unintelligible loudspeaker

Case of Cambodia's finest

Durian stall (taken from a moving tuk-tuk and the scooter drove into shot)

Appetising platter including frogs, snakes and beetles

Baskets of creepy-crawlies at the market

Mekong fish

Suki soup with too-cute fishball

Plate of bugs that some friends and I actually *did* eat. Water-beetles are incredibly crunchy but don't taste like much. Silkworms taste like caterpillars (yes I know this for a fact). Crickets are pretty nice. Tarantulas are just plain creepy.

"Cafe d'doh gore d'goh" - iced coffee.

Huh? This is icecream.

Old Wound

An 8-year-old boy presents at Surgical clinic with an obviously old wound on his foot which hasn't healed properly. 

The doctor asks how long ago it happened.

"Mapay chnum" he replies, in Khmer.

Twenty years.

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Paediatric Dengue

Oops, almost forgot that I was here on medical elective!

I spent last week on the Infectious Diseases ward and learnt all about Dengue Haemorrhagic Fever from the Head of ID and Cambodian expert on the disease. So that'll be really handy if I come back to Cambodia one day. Otherwise, in my very un-tropical part of the world, I'll be lucky if I ever see it again.

Basically, there are four subtypes of Dengue (D1-D4). Your primary infection is the first time you get infected, and you'll develop "classic dengue" which isn't particularly dangerous. But then if you get infected with a different subtype, your body mounts a huge and inappropriate immune response, releasing histamine which causes capillary leakage. 

This leads to oedema, pleural and peritoneal effusions (and an increased haematocrit to >20% from the baseline from haemoconcentration). Platelet count drops, so you bruise easily and develop petechiae (little red spots), and risk DIC ("consumption coagulopathy") and massive internal bleeding. Your liver becomes painful and enlarged due to microabscesses. You get joint pains, headache, eye pain, lose your appetite and have no energy. You're treated with fluids and an almost-therapeutic dose of paracetamol to help with the pain (not too much because your liver is inflamed).

And to top it all off, you're four years old and people with white coats keep coming around making you cry.

And that's paediatric dengue.