Constant Nomad

Wholesale Therapy

2009-08-17T21:22:00.004+10:00

Big news today: Costco opened its first Australian warehouse in Melbourne today! That’s right, the American institution of purchasing stuff in packs of 50 right off the shipping pallet, all under an expansive industrial roof, has finally reached across the Pacific to this corner of the world. I know they have locations in Taiwan, Korea and Japan, but as arguably the most Americanized countries in the Asia-Pacific region, it is high time for Australia to finally have a Costco.

For people who are not familiar with Costco, it is a completely different shopping experience than any other place. The biggest difference is that it has done away with the whole pretense of presentation: aisles are flanked not by shelves, but by pallets on which items on offer are shipped. The whole place is a steel-and-concrete warehouse; there’s no pop Muzak playing in the background and no shop assistants helping you trying on the shirt you want to buy. What you see is what you get. Items range from clothes to diapers, from groceries to pet food, from toiletries to cleaning supplies. You won’t find fifty varieties of canned tuna, but what you do find comes in packs of thirty. Want to get some toothpaste? There are packs of five on sale. Toilet paper? How about the packs of fifty? Want some apples? They have 10-lb bags. The big draw is that, per item, the prices are usually quite a bit lower than what one can find in retail shops. Obviously, you don’t go to Costco to pick up some bread and milk, because you will invariably come out with a hundred other things and $300 poorer. It is a boon for budget-conscious and well-disciplined people, heaven on earth for hoarders, but a giant sink hole for the impulsive shopper.

Now, Australians, or rather Melbournians, at least for now, will be able to stock up on a year’s supply of toilet paper and laundry detergent in just one trip. Apparently, there was a two-hour wait for the checkout today. People everywhere just love a bargain.

I wonder when they will open one up in Sydney.

Thirty-roll packs of toilet paper on sale at the Livermore, California, Costco. I had this picture taken to show my friends in Australia because I didn’t think they would ever see such a sight.

Graveyard Shift

2009-07-29T22:09:00.000+10:00

For the next four weeks, I will live the vampire lifestyle, or at least keep the same hours. I am assigned to do the graveyard shift: from 10:30 pm to 8:30 am the next morning. The shift started in the middle of the first week and goes for seven nights straight. I then have seven days off, followed by another block of seven nights, then I have five days off before starting back on regular schedule. So, in four weeks, I will actually be working for fourteen days.

So during the fourteen days when I will be working, my sleep cycle will be upside down and turned completely around. Having done night shifts during my emergency term, I now have a bit of experience on how to ensure I have a good day of sleep in between my shifts. I have made my room into a bat cave: windows are shut, blinds are closed, heavy curtains ensure that as little light as possible leaks in, add eye shades from long-haul flights, and my brain will think it’s the middle of the night even during high noon. I set the radio to the ABC (Australian Broadcasting Company, similar to NPR in the States) to serve as background noise. Ear plugs are handy for when the neighbors decide to rev up their cars. For the first couple of shifts, Phenergan just makes the quality of the sleep a little bit better without me feeling groggy when I wake up in the evening.

I actually think doing the graveyard shift allows me to have time for other things. I can wake up in the late afternoon or early evening and still have time to go to the gym, visit friends, and leisurely cook my meals before I start my shift. The downside is that, the weekend, when everyone is out, is the middle of the week for me and I have to follow the same sleep routine. It does not matter how gorgeous the day is or how inviting the beach may be, I have to go straight home for bed after my shift.

To push my sleep schedule back, last night I stayed up until 5:30 am before dragging myself to bed. I had a decent day of sleep today, so tonight I will start pretty fresh. But I know it will be a struggle by 4:00 or 5:00 in the morning. But that’s when my good friend joe will come to my rescue – a couple cups of it, and I can stay awake at least until sunrise. Then it’s pretty much smooth sailing to the end of the shift. Unless, of course, if the arrest pager goes off.

Okay, my shift is about to start; think positive: no arrests tonight, no arrests tonight…

Juicy Juice

2009-07-28T12:43:00.001+10:00

The house I am renting this year has a few huge orange trees in the back. And now they are all fully laden with ripe oranges and mandarines. Everyday, a dozen or so of them drop from the trees. As my housemate is not big on citrus fruit, I now find myself with more oranges piling up than I can shake a stick at. I have to get through them in a more efficient way than simply eating them. I can eat until I get sick and still wouldn’t make a dent in the pile. Besides giving them away, juicing them would be the most efficient way of consuming the mountains of oranges before they become part of the compost pile.

Ah, drinking freshly made orange juice is one of the simple pleasures in life (I know, I don’t ask for much). I can’t drink the stuff from the supermarket anymore. Even the “not from concentrate” version tastes “preserved.” One and half liters of the juice wouldn’t even last me two days. I am drinking so much of it that I am sure I pee vitamin C every day. But here’s the good news: no scurvies for me!

Clothes Lines

2009-07-27T22:12:00.001+10:00

For most Americans, the image of freshly laundered clothes hanging in the breeze, soaking up the warmth of the sun, evokes the feeling of a quaint bygone era. Today, the crude imitation of “fresh spring breeze” scent that comes from a dryer sheet would be about as close as most people get when it comes to drying their clothes outside. In the US, not only are clothes dryers part of the standard household appliances, in many parts of the country where home owners associations rule with an iron fist, clothes lines in the backyard are actually illegal. They somehow have come to be associated with poverty, are considered eye sores, and thus, have a negative impact on property values. People throughout the country have to fight tooth and nail the get the “right to dry” law passed.

In Australia, that stigma associated with clothes lines in the backyard never seemed to have existed. Clothes lines like this one in the backyard of the house I am renting are not only a standard fixture in almost all single homes in Australia, they often are placed right in the middle of the open yard as the most prominent feature. Neighbors don’t grumble about having to look at your skivvies flapping in the wind; no one hyperventilates over being mistaken for living in a poor house because of the clothes line in the back.

Being the stingy greenie that I am, I absolutely embrace the clothes line for saving me money and being good to the environment. Yes, it takes longer to hang the clothes up on a line than simply throwing them into the dryer and push a button. But I look at it as part of my morning stretches. Yes, the weather dictates when I can do my laundry. If it rains on my day off, I just wait until the next dry day; I have plenty of underwear and socks. Worse comes to worst, if I really need to do laundry when it is raining, I hang them up on a foldable drying rack under the patio cover. On nice sunny weekends, my morning sometimes starts with the ritual of me standing out in the yard under the warm sun, with blades of grass between my toes, pinning the wet laundry up on the spinning rack. I then go out to do whatever for the day, not having to worry about my clothes getting wrinkled for sitting in the dryer all day. In the afternoon before the sun sets, the clothes are ready to be taken down. The wind has done the ironing for most of the clothes. And that smell of fresh air and sun soaked into the clothes just feels so – natural.

I just heard the washing machine buzz. Better go hang them up.

A bee visiting the flowers in the yard

I’m Still Alive!

2009-07-25T21:09:00.001+10:00

Yeah, I am still here. It has been over six months after the last entry on my blog; now I am back.

Short summary of what happened in the last six months. I worked. Okay, you are all caught up now. Here is a little more detail if you are interested.

My first term was in vascular surgery – arguably the busiest term in the whole hospital, so it wasn’t exactly a way to ease into this back-to-full-time-work-and-trying-to-be-a-doctor internship thing. Having been thrown into the deep end, I basically spent the whole ten weeks trying to keep my head above water. Fortunately for me, I was in a team of incredibly good registrars and resident. So despite the hectic days, I felt like I was very well supported. The hours were grueling – by non-North American standards – from sixty-five to seventy-five hours per week. I felt like I only came home to sleep. So I spent the time that I had off either cycling along the beach or up the mountain or going to the beach with a book.

During that time a half dozen or so blog entries gathered in my computer and I never got around to finishing them. The perfectionist in me just would not allow myself to put them online without editing. And so in my computer they languished – half done, clumsy, and not fit to see the light of day.

My second term was in emergency. I had a blast! The work was interesting; the team was good to work with, mostly; one of the consultants has the ability to make interns feel like the most inadequate person in the world. I always stuttered when I handed patients over to that consultant. The hours were awesome: each week consisted of four ten-hour shifts and three days off. Having come from vascular surgery, forty hours per week felt like a holiday. So I treated my days off like holidays: biking, going to the beach, reading non-medical books, going to the gym (and sauna), going to Sydney, etc. My blog continued to sit idle. It had already been a couple of months, my unfinished entries were still waiting to be edited, but they were getting lower and lower on my priority list. I figured: who reads it anyway?

I was in the States last month on my annual leave. A couple of friends I saw mentioned that they hadn’t seen anything new on my blog. I even got emailed from some random person asking about it. So apparently people do read it.

All right, now that I have left my blog static long enough to have lost all three of my readers, I am going to give it another go.

New Beginning

2009-01-12T20:49:00.001+10:00

It is barely six o'clock, but I am wide awake. Today is the first day of a week of orientation for the batch of new interns. The mix of nervous energy, expectation, and anticipation swirl around my head as I head to the auditorium of the hospital. It is exactly the same feeling as the first day of medical school four years ago. We gather in the foyer, introduce ourselves to one another, and make the obligatory "Hi, where are you from? What uni did you go to? What made you come to Wollongong?..." small talk. There's a buzz of energy in the room; I can feel the excitement in the air. After all these years of putting our noses to the grindstone, it really is exciting that we are finally going to take the first real step toward a lifelong career, and for me, a second career. I am finally going to have a real job and a regular income again. The cynic in me knows that, as time goes by and as we go through the trials and tribulations of post-graduate training, the enthusiasm and idealism we have today will seem naive sometimes. But today, I feel like my whole life is laid out before me and the possibilities endless. Today, I feel like an adult again.

In the Nick of Time

2009-01-10T18:46:00.000+10:00

After a somewhat tense and suspense-filled two days, I logged onto my email this morning for the nth time to check my visa status.

It turned out that the only sure way to get things moving was to get on the phone. So, for example, when things like the person assigned to your case got moved to a different section of the Department of Immigration and your file ended up sitting on a desk without anyone looking at it for a month happen, you can get someone to maybe give a sideway glance at the big pile of paper with your name on it. And when they call you back saying that they can't process your paperwork because of some technicality, you can get the hospital sponsor to call them back and tell them to stop being ridiculous. After a bit of back-and-forth like that, I was finally promised that my visa would be finalized yesterday afternoon.

This morning, I logged onto my email, only to find that the notification for my visa's approval in the spam folder. Maybe it was the word "approved" in the subject line or that the text of the email sounded too much like one of those get-rich-quick come-ons, the email filter had decided that it was too good to be true.

That must be the best piece of spam I have ever got.

Sydney Tour

2009-01-07T18:44:00.002+10:00

Today I am on a whirlwind tour of Sydney. But it doesn't involve the Harbour Bridge; there's no visit of the Opera House; nor am I getting anywhere near any of the beaches. Today is a day dedicated to satisfying the Australian bureaucracy.

I got back to Brisbane early yesterday morning. I went over to the med school to pick up my diploma, had coffee with a good friend who is heading back to Canada, went back to the place I last lived and re-packed my bag - I needed to dump out my travel gear and pack some work clothes - and headed back to the airport for a night flight to Sydney.

The flight was delayed - first by twenty minutes, then it became half an hour, then it stretched to forty-five minutes. At the end, the flight was one-and-half hours late. I flew on Virgin Blue, another budget airline - well, you got your hits and you got your misses. My housemate picked me up from the airport. By the time I got to Wollongong and settled into the hospital quarters, it was well past midnight.

Which brings us to this morning. My housemate is taking me on a tour of the backstreets of Sydney, but mainly to visit two places: the New South Wales Medical Board and the Department of Immigration. I am supposed to start orientation for work next Monday, but I don't have my work visa sorted yet. Besides the mountain of supporting documents I had submitted, Immigration wanted to see my diploma and registration with the Medical Board. The New South Wales Medical Board requires that all interns coming in from out of state to register with them in person.

With my diploma in hand, I walk into the Medical Board. Registration itself is actually a pretty painless affair, it takes all of ten minutes; the most difficult part is getting to their office. Then next step is to drive to Immigration and convince them that I have in fact graduated from medical school and am now a registered doctor. It is one of those take-a-number-and-wait affairs, not unlike what one would do at the supermarket deli, except in this case, my fate - whether I will be able to work in Australia or be packed off onto the next flight out of the country - is firmly in the hands of the person behind the counter. With my paperwork handed over to them, my day is finished. The only thing I can do now is to wait while my paperwork churns through the mysterious workings of the innards of the Australian bureaucracy. Perhaps the planets will align and the person processing my paperwork will come back from holiday in a good mood and I will get my visa on time to start my orientation next week. At this point, I kind of wish that I can grease some palms and get things sped up a bit.

Or maybe I will occupy myself with the next task - looking for a place to live.

Back to Oz

2009-01-05T20:39:00.001+10:00

Vacation is over; I am heading back to Australia. I am flying the no-frills Tiger Airways from Macau to Singapore. After a seven-hour layover, I will be flying the red-eye on Qantas from Singapore to Brisbane.

Macau International Airport is a shiny and modern airport built on reclaimed land. With only a few small airlines operating out of it, the airport feels deserted when I check it. Within ten minutes, I have checked in, cleared customs, and am sitting in the departure hall. With almost two hours to kill before my flight, I occupy myself on the free internet terminal by the boarding gate. The sun beams in through the glass-and-steel eastern facade of the terminal, casting a warm glow on the lounge chairs, the shops, and the waiting passengers in this brisk morning. With a cup of coffee in hand, I stare out onto the single runway that appears to be floating just above the shimmering South China Sea. It is still close to an hour before my flight. My eyes look out toward the horizon; the outlying islands of Hong Kong seem to be faintly visible. My mind wanders here, there, and everywhere. This has got to be the most relaxed I have ever been when waiting for a flight.

A seven-hour layover is just too long to spend inside an airport, even for an excellent one like Singapore's Chang-I Airport. My friend Vignesh, who is a local, has the afternoon free. He meets up with me at the airport. We head into Orchard and the waterfront for a few hours. The tropical afternoon heat hangs heavily over the city; it takes extra effort to just walk along the street, as though we are trying to walk underwater. To revive myself, I have my fill of kaya toast washed down with that most delicious diabetes-in-a-cup: teh tarik. Before long, it's time for me to get back to the airport. I say goodbye to Vignesh, head into the terminal, and get ready for the eight-hour flight ahead.

I'd better get some sleep on the plane tonight. Tomorrow will be a full day of running around Brisbane, capped by a night flight to Sydney.

Day of Reckoning

2008-11-30T23:44:00.000+10:00

This is it: the result of four years of formal medical education all hinges on our performance in three hours this afternoon. The sixty or so of us taking the exam this afternoon get to the hospital and wait around the lobby to be called in. We are then herded into another room, wait some more. The room is humming with anxiety; some of us chit chat to distract ourselves while others flip through pages of notes. Psychogenic diuresis kicks in, we drink more water; the toilet is in constant demand. After an eternity, we are lead out of the holding room to our respective stations. At the sound of a buzzer, the exam is officially started.

Three hours later, the last buzzer is accompanied by a collective sigh of relieve from all of us. We stream out of the hospital, some recounting the points they failed to make, some swearing they will be blind drunk tonight. I am just happy the whole thing is over.

In the evening, I join my fellow classmates at the Royal Exchange Hotel, the local watering hole frequented by college students, for a night of celebrating the end of medical school and, for many people, to say good-bye to each other. Soon enough, we will all head our separate ways.

We greet each other by a hearty “Congratulations, Dr. [insert last name]!” and point out the novelty of being called doctors. When used in front of my name, it still sounds so oddly formal. With beers in hand and over the amped up guitars by a cover band, we talk about where we will be next year, what specialties we want to go into, and the possibilities the future might bring. The buzz goes late into the night.

We have done it! I have done it! It feels surreal – to not being a student anymore, to not having to worry about studying tomorrow, to finally have a job again.

One Day More...

2008-11-29T21:47:00.000+10:00

Until this is all over! The big, end-of-medical-school-and-must-pass-to-graduate exam is spread out over today and tomorrow. Our class is split into four groups: Saturday morning, Saturday afternoon, Sunday morning, and Sunday afternoon. As always in this kind of situation, I have the misfortune of being allocated to the Sunday afternoon session, just to ensure that the agony of endless waiting is prolonged. The exam is the live, face-to-face type consisting of nine live stations in which we are given scenarios and are instructed to talk to or examine or device a management plan for the real or volunteer “fake” patients.

By now, half of the class has already finished their exams. I am sure they are all appropriately in an altered mental state, but continue to quaff large quantities of alcohol in various disguises which, for many, has been the one constant through the four years of medical school.

While those half of the class are blowing off steam and generally engaging in wanton revelry in ways that may potentially be career-enders should they wish to enter politics later in life, this half – well, me at least – is trying to use our psychic power to predict the questions and topics that will be on our exam tomorrow. They had a cardiovascular system examination station today? I think it might be respiratory or gastrointestinal system tomorrow. They had an O&G station consisting of contraception advice and placenta previa today? It could be pre-conception counseling and pre-term labor tomorrow. Today’s ophthalmology station had patients with glaucoma and retinitis pigmentosa? We’ll probably get a couple of patients with macula degeneration and diabetic retinopathy…

No more studying. I am as ready as I will ever get. It’s time for some sleep.

Turkey of a Day

2008-11-27T22:51:00.000+10:00

Happy thanksgiving! Hope your turkey is delicious.

Because I’m not having any.

I’m getting used to doing nothing for Thanksgiving now. For one thing, in Australia, today is just the fourth Thursday of November and nothing more. Secondly, we have our big, end-of-medical-school-and-must-pass-to-graduate exam this coming weekend. Any holiday would have to take a back seat to studying. For the last few days, I have set up shop in the library with my study group, pounding the past exams. And today was no exception.

So I came back in the evening, cooked up some quick pasta, and called it a day.

Maybe I can do some kind of Thanksgiving dinner next year.

Ten for Ten

2008-11-21T17:53:00.000+10:00

In the early afternoon, I walk out of the children’s hospital with the other student in the rotation, feeling tired but relieved. Now that the exam for pediatrics is behind us, what are we going to do?

First, a beer is essential. Then, I am just going to enjoy the sunny afternoon.

Next week is study week for the big exam: everything we have learned over the last four years will be fair game. The diploma is going to be hinged on whether we pass this exam. So, the pressure is on.

But for this afternoon, I’m not going to think about it. Maybe I’ll even go see that new Bond movie tonight.

All Studies and No Exercise

2008-11-19T23:56:00.000+10:00

Ugh, I feel like my body is atrophying. This is the last week of the rotation, which means serious study time, which is encroaching on my exercise time. For a whole week now, the only exercise I have been getting is my bicycle commute to and from the hospital. At a measly seven kilometers roundtrip, the commute is long enough to make me break a sweat, but not long enough to make me feel like I got a workout from it. Well, it’s better that than nothing.

Halelujah

2008-11-17T22:35:00.000+10:00

I guess I can say "Halelujah!" that it's almost the end of medical school. But this halelujah actually refers to one of my extracurricular activities - the Queensland Choir. We are singing Handel's Messiah this year and this is the final week of rehearsals. Last week, with my unlucky viral infection, my voice dropped an octave and I could only sing about two notes. Singing then would probably get me kicked out of the choir. So, with my voice recovering over the weekend, I feel like I should join the last two rehearsals before our concert at City Hall this coming Saturday.

This will be my final performance with the Queensland Choir. The Messiah is always fun to perform. It was one of the first concerts I had performed in during my undergraduate years with University Singers. In the following ten years or so, I had performed it with other groups a few times. The complexity and intricacy of the masterpiece makes it a challenge but also a joy to perform each time. And each time I gain a new appreciation for Handel's genius.

After this concert, the choir will break for the summer and next year, I will be far away from Brisbane. During the three years that I had been able to sing with the Choir, I had a lot of fun learning new music and making new friends. With no formal music education and not able to play any instrument, I can count on singing as the artistic complement to the scientific side of my life. Being able to sing with a dedicated group of enthusiastic singers and lose myself in the music is incredibly stress-relieving, even during rehearsals when we get yelled at by the conductor.

Halelujah!

Downed by Germy Kids

2008-11-10T19:33:00.000+10:00

Everyone else on the pediatric rotation has been getting sick. It seems that whatever virus the sick kids have been coming into hospital with, it is now being passed around our group of med students. A few of my compatriots have already been feeling miserable as of late. Amidst the constant sniffling, I have luckily avoided getting hit - until last weekend. A hint of a sore throat on Friday brewed over the weekend and, by today, has become a full-blown case of viral upper respiratory tract infection. This has got to be the worst time to be sick. There are only two weeks until the end-of-rotation exam and then another week until the final exam. I really can't afford to be sick this close to two important exams. I know it's probably viral and I just have to let it run its course. If it's caused by what the kids have been spreading around, I should be feeling pretty sick these couple of days but I will be fine come exam time. Let's hope it's that and nothing worse.

A Historic Day

2008-11-05T18:30:00.000+10:00

After lunch, I am on my way to the ward to find more information from a patient's chart for my case presentation when I decide to stop by the staff tea room for a cup of coffee. As I enter the room, I hear the TV on with sound at full volume. A couple of nurses are organizing charts while looking up occasionally at the TV. The local TV channel is carrying live coverage of the US election. I make my cup of coffee and see Barack Obama on the screen getting ready for a speech. At the bottom of the screen flashes the designation: "President-Elect." As he starts to speak, I sit down with apt attention and sip my coffee absentmindedly.

Earlier in the day, I looked up the election returns online whenever I could. As I watched one swing state after another going to Obama, first Pennsylvania, then Ohio, then Virginia and Florida were starting to look more and more blue, I became increasingly hopeful even though the results were only based on exit polls. It almost sounded too good to be true - what, no "too close to call", no outcries for recount? I wasn't going to get my hopes too high; I was almost anticipating that some of the swing states would turn yellow, and then we'd get bogged down in yet another round of law suits for recounts and countersuits to stop recounts. I was telling myself that I wouldn't be convinced until the official counts were confirmed. Now that McCain has made his congratulatory phone call to Obama, I am relieved that the drama that had followed the last two elections won't be repeated this time.

I watch as President-Elect Obama speaks in his trademark soaring oratorical style. I notice that my eyes grow moist as his infectiously hopeful speech goes on, his eloquence a stark contrast to what we have had to suffer through in the last eight years. Images of his elated supporters crying, singing, and celebrating flash on the screen. Obama's election has brought hope to me and to many people who feel the country is heading in the wrong direction. But this is only the beginning; we can't expect Obama to fix everything. The things that are going wrong in the US are beyond what any one person can do to fix. He is inheriting a country with its economy in the dumps, a health care system already running over the cliff, and the only thing constantly going up is the national debt. These problems won't be solved overnight, but I know the one thing Obama can do as soon as he takes office is to repair the United States' image internationally. To paraphrase a popular credit card commercial - one economic bailout package: $700 billion; fix the health care system: $50 gajillion, to have the United States regarded around the world as the beacon of freedom and democracy once again: priceless.

With Obama's speech over and the local station switching back to its regularly programming, I dab my eyes dry and start my way to the ward again. I walk out of the staff tea room with a slight spring to my steps; I, as an American, am standing taller today.

Burning Out

2008-11-01T18:24:00.000+10:00

There is a recent article on the New York Times about medical students in the US feeling burned out and depressed that contains some alarming statistics: 11% of those surveyed have had suicidal thoughts from depression, almost half of medical students surveyed suffered from emotional exhaustion, depersonalization, and a low sense of personal accomplishment. Among the factors cited are the constant lack of sleep, the pressure to excel, the hazing from senior students and residents, and having the firehose of information aimed at them non-stop. In the article, the author, an accomplished specialist herself, recounts her years in medical school when she felt miserable but unwilling to admit it because she did not want to admit to failure amidst the fierce competition among her fellow students. The article paints a picture of cut-throat competition and every-man-for-himself mentality in the US medical community.

After reading that article, I feel especially fortunate that I had decided to go to medical school in Australia. Now in the final month of medical school, I can say that I have not had any reason to feel burned out in the four years of medical school. Perhaps being a few years older than the average medical student has given me the emotional maturity to better deal with life's ups and downs, but if this article is an accurate reflection of the system in place in the US, I think my coping skills might have been pushed much closer to the limit there. Sure, the firehose of information has always been there, as was the pressure to excel, but to a much lesser degree because internship placements in Australia has nothing to do with one's rank in medical school. Any lack of sleep I have had was due to things unrelated to medical school; I don't remember any incidents of hazing by senior students and residents. In general, I never felt that I was alone in the course. Everyone I know has helped one another the whole time, whether it was to discuss the finer points of some intricate metabolic pathway or to lean on another's shoulder for emotional support. I would say camaraderie and cooperation are the better words to characterize the last four years.

I am not saying the medical school system in Australia is better than that in the US. The competitiveness of US medical schools is the impetus behind the constant innovation, for example. But for my own sanity and mental health, I am glad that I have been able to enjoy the relative tranquil four years in Australia.

Playing House

2008-10-31T10:59:00.000+10:00

During a teaching session with one of the pediatricians today, I felt like we were the characters on House.

We saw a thirteen-month-old baby girl who was admitted to the ward yesterday. Through her mother, we learned that the baby had a previous history of Hand, Foot and Mouth Disease, which is a viral infection that happens commonly in children. It ran its course and she got better. Then her mother noticed a rash and diffuse redness in the area covered by the diaper. The mother treated it like a diaper rash. After a couple of days, the baby had not passed any bowel motion and was crying incessantly. The mother thought she had constipation and gave her some enema. The baby opened her bowel but was still unwell. At this point, the mother noticed that one of the baby’s legs was swollen from the hip to ankle and that she was spiking fevers intermittently. The mother finally brought the baby in to the children’s hospital Emergency Department. After having five different doctors taking a history from her, the mother clued in to the fact that the doctors were suspecting a non-accidental injury – i.e., child abuse. After a skeletal survey of the baby turned out normal, more investigations revealed the final diagnosis: the baby had septic arthritis of the hip. Ok, so the diagnosis was not House-worthy, but the process just made me think of the show.

There we were, three med students taking turn asking the mother the history yet again. Each time we were lead down the garden path, only to find that each piece of new information made us do a complete U-turn and think about a different process. Sure, all we did was take the history, we didn’t do any of the crazy things on House like going to the patient’s home and digging up the sandbox (as if doctors really do that in real life). Unlike House, our clinical coach, the pediatrician, was actually very nice to us and to his patients. So maybe it wasn’t like House after all, but I really enjoyed the exercise.

Going into the rotation, I didn’t think I would like pediatrics that much. But I think it’s growing on me.

Baby Check

2008-10-30T22:01:00.000+10:00

I enjoy going to the neonatal ward. With all those chubby newborns and happy parents around, you can’t help but smile and share their joy. Yesterday I followed a resident on the ward and did a few well baby checks, which is one of the skills we have to learn during this rotation. Before each newborn is discharged, they are given a once-over by a doctor to make sure they are normal beyond having ten fingers, ten toes, and no obvious deformities.

Like everything else in medicine, there is a system to doing a baby check. You literally go from head to toe and front to back to examine the baby. I especially enjoy doing the primitive reflexes like the grasp reflex in the hands and feet, a telltale sign of our arboreal ancestry, and the Moro reflex, which is believed to be the only unlearned fear in the newborn. Today we had our baby check skills assessed by the neonatal consultant. The way I interacted with the baby I checked must have looked really natural, the consultant asked me afterward if I have kids of my own. Well, besides the four babies I delivered during the O&G rotation, yesterday would have been the first time I handled newborns. So maybe I do have a knack for handling little babies.

In Retrospect: Venice

2008-10-26T16:36:00.018+10:00

Not much needs to be said about Venice. Everything about it makes it an attractive destination: the labyrinthine canals, the history behind every building, the festive atmosphere, those gondolas, the colorful houses, even the throngs of tourists. My short trip to Europe with my sister in September 2002 included Venice in the spur-of-the-moment itinerary. Even though we only stayed for two days, the time was well spent getting lost in the backstreets, island-hopping by water-taxi, and filling my daily quota of gelati.

Venice is a collection of islands scatter through the lagoon, with the main island connected to the mainland by a train bridge.

View of San Marco Square from the poor-man’s gondola – the utilitarian water-taxi

San Marco Square was deserted in the early dawn.

At this early hour, the famous and famously annoying pigeons were the only visitors to San Marco Basilica and Campanile.

The gondolas were moored to pylons at the end of San Marco Square with San Giorgio Maggiore Island in the background.

Later in the day, the gondolas would be put into service for all the tourists who wanted that romantic ride through open sewage, er, I mean the canals.

The juxtaposition of gondolas and a warship

The water lapped at the edge of San Marco Square.  Flooding has become a common occurrence in recent years due to both the gradual sinking of the city and rising level of the sea.

Gondolas going under the Bridge of Sighs

Get your tschochke along the waterfront

Art student or watercolor master?

While gondola rides are considered a must-do in Venice, we got around by the much more utilitarian water-taxi.

Just a quiet corner in some back canal

All the ubiquitous gondolas were starting to make the whole place feel like a theme-park, only tourists were riding them, after all.

Out on the Island of Burano, the residents must have been competing to see who has the house with the loudest colors.

An American suburban neighborhood association president would surely go apoplectic upon laying eyes on such gross violation of uniformity and the distinct lack of beige.

Filling up on gelato

Donating to a Good Cause

2008-10-24T16:36:00.000+10:00

On Monday I had my car towed to a nearby garage. The mechanic called me the next day and broke the bad news. Just as I had suspected, the engine was completely fried. The cost of repair would come to be about the same as what I had paid for the car two years ago. After thinking about my options, I decided to cut my losses. I will probably only get a token amount if I sell it for scraps. So, just like what my parents did with their dead cars years ago, I decided to donate its corpse to charity. A quick Google search landed me on the website of the Cerebral Palsy League. A couple of phone calls later, my car is officially off my hands.

I hope they actually get some money out of it, because I’d like to think that someone with cerebral palsy will benefit, in whatever little amount, from the death of my car.

A Timely Death

2008-10-19T20:34:00.001+10:00

This morning, my housemate borrowed my car to go down to the Gold Coast to pick up some of her stuff. In the afternoon, my phone rings. My housemate asks me how long ago I last put oil in my car. A couple of months ago, I guess. Well, the car is now sitting at a service station next to the freeway exit, completely dead.

I borrow a friend’s car and drive down to Coomera where my housemate is stranded with a carload of her stuff. I try starting my car. Wrrrrrrrr, wrrrrrrrr, wrrrrrrr… The starter works in vain, the engine won’t turn over. It sounds like the engine has had it and decided to call it quits today. Like many old cars, my car has been burning oil every since I got in almost two years ago. I have been anticipating its demise, but have been giving it palliative oil changes. It has surprised me by chugging along with no complaints for the last two years. And apparently, today it has decided to go out, not with a bang, just a lot of shakes and black smoke out of the tailpipe.

I help my housemate transfer her stuff to my friend’s car and head back to Brisbane. My disabled car will have to wait until tomorrow to be towed.

Casting My Ballot

2008-10-14T22:32:00.000+10:00

Our election is coming up in exactly three weeks. Last year I put in my request for an absentee ballot just a little too late, so this year I made sure to send in my ballot application early. I spent the whole of last evening online looking up the positions of candidates and the details of all the ballot initiatives. This morning I fulfilled my democratic obligations by unceremoniously putting the completed ballot in the mail. I hope it gets there by November 4th.

Wait, does California count absentee ballots if the race is not too close to call?

Kids Emergency

2008-10-13T21:30:00.001+10:00

This week I am rostered on at the Emergency Department. Over the last couple of years, I have been slowly developing a liking to emergency medicine. Even though it is not always the adrenaline-pumping full-resuscitation cases with patients bleeding profusely as doctors bark orders while jumping on the patients’ chests as the stretcher races down the hall – in fact, that’s rarely the case – I really like the variety of presentations that’s characteristic of the specialty. So, I really look forward to my week at the children’s emergency department at the hospital.

Today I am on from 3 pm to 9 pm. This being my first day, I am still trying to find my way around the department. The consultants and registrars are incredibly nice to us. I have noticed that all the pediatricians I have met so far have been good teachers and really pleasant to work with. It makes sense: in order to be able to get kids to cooperate, the doctors just have to be pleasant to work effectively. It is hard enough to get kids to cooperate during examinations, a grumpy doctor would basically make that an impossible proposition.

The kids around Brisbane must have had a rough weekend. Late in the afternoon, the waiting room is filled with kids with various injured joints. As a medical student, all I can really do to help out the registrars and residents is by seeing the subacute cases: a sprained ankle, a swollen thumb, a rugby-related knee injury… Before long, it’s nine o’clock – the end of my shift. I have not had dinner, but I don’t even feel hungry. Normally, by this time, my thought would be on nothing but food and I’d be gnawing on my pen already.

“You coming in tomorrow?” the registrar asks me. “Yeah, three to nine again.” “Good, I’ll be on in the evening again. See you then, I’ll get you to do some good work.” With that, I change into my cycling clothes, hop on my bike, and ride down the quiet road toward home.

In Retrospect: Tiger Leaping Gorge

2008-10-12T16:13:00.024+10:00

Tiger Leaping Gorge, the name alone evokes images of peril, mystique, and majesty. In early December 2003 when I was traipsing around southwestern China, I made sure to do the three-day hike through the gorge. It is not in a national park, nor is it a “protected area”. It is simply a place where people happen to live in a stunningly beautiful setting. Two main trails runs through the gorge: the low trail was being expanded to accommodate cars and tourist buses, the high trail, well trodden by villagers living in the area, remained the footpath that connects the little villages that cling on to the side of the steep mountain. The villages made it possible for people who had no camping gear to see the place. I hiked with a small backpack, ate and slept at guesthouses run by entrepreneurial villagers who took advantage of the fledgling tourist industry being developed around them.

The gorge, flanked by the Jade Dragon Snow Mountain on one side and the Haba Mountain on the other, is reputed to be among the deepest in the world. The jagged peaks of the mountains drop almost four thousand meters to meet at the bottom, a mere twenty meters apart at the narrowest, squeezing the upper Yangtze River through a series of cascades and rapids. I hiked the relatively short high trail with a few other backpackers, enjoyed the warm Naxi hospitality, and visited the bottom of the gorge where legend had it that a tiger had leapt across to safety while being chased by a hunter.

Tiger Leaping Gorge is located in northern Yunnan Province in southwestern China.

At the western end of the gorge, the upper Yangtze, also known as Jinsha Jiang or the “Golden Sand River”, flows quietly through relatively gentle terrain.

Upon entering the gorge on the High Trail, the jagged peaks of the Jade Dragon Snow Mountain was in view.

The Naxi House was a little guesthouse run by a local Naxi family.  The Naxi people are the predominant ethnic minority group living in the area.

Maize and pumpkins being dried for the winter

Even the view from the toilet was spectacular.

Persimmons being dried in the sun

Higher up on the trail, the full length of the Jade Dragon Snow Mountain came into view.

I spent the night at the Tea Horse Guesthouse, where I was greeted by the owner with nuts, snacks, and a bong with locally harvested “herbs.”

The next morning, it took a long time for the sun to rise above the peaks across the gorge.

After breakfast, the incredibly hospitable Naxi Mama sent us off on our hike.

The people carved out terraces and lived off the land.

The trail wound its way around the mountain, veering precariously close to the edge at places.

Taking a break with Inbal, Keeley, and John

The setting sun covered the gorge in a dramatic show of light and shadows.

The daughter of the owner of Sean’s Guesthouse swept the courtyard clean early in the morning.

The peaks of the Haba Mountain towered over the little hamlet at the eastern end of the gorge.

Every inch of arable land had been converted into terrace fields.

The water buffalo took a break as his elderly owner looked on.

The height of the mountains allowed the sun to grace the bottom of the gorge for only a couple of hours a day.

The river roared through the narrowest part of the gorge.

The vista opened up again at the eastern end of the gorge.

Pre-Approved Straightjackets

2008-09-30T22:10:00.000+10:00

Seeing how all of us are going to be doctors and earning an income in little more than three months, the university medical society organized a “Finance Evening 2008” tonight in case we don’t know what to do with all these money we’ll be making.

We gathered at the auditorium. A bunch of people in spiffy pin-striped suits took turn and gave us talks on the ins and outs of managing personal finances and services their companies offer. New words were being thrown around: salary packaging, superannuation, negative gearing, capital protected borrowing… I’ll have to look up these words later, but I did learn that, apparently, there are so many ways for these companies to minimize our taxes – and they are all legal. I’m listening, tell me more…

In the middle of their talks, almost every company told us about these pre-approved lines of credit up to $10,000 sitting there waiting for us as soon as we start working. And then there are car loans and 100% home loans. They are practically throwing money at us. I guess the credit crunch in the US has not come across the Pacific yet. Some may salivate at these “generous” offers, but, to me, each one of these pre-approved loans dangling in front of us looked like someone holding up a straightjacket, just waiting for us to turn around and put our arms through, then ziiiiiiip, we’re trapped for the next thirty years. I am already graduating with a bunch of mortgage-size student loans; the last thing I need is another loan on top of it, no matter how favorable the terms may appear to be.

So, no, I don’t need a new car, my little three-cylinder Daihatsu with 240,000 km on it will do just fine, until it dies. House? I’ll be okay living in my rented hovel as long as my net worth is in the red. No, I don’t need a line of credit either. Now, about that tax minimization…

The Beginning of the End

2008-09-29T22:08:00.000+10:00

Yes, it’s the last rotation of medical school! But, sigh, it’s arguably also the toughest one – pediatrics. It’s like everything we learned in the last two years all rolled into one: internal medicine, surgery, psychiatry, emergency medicine, and all those subspecialties like nephrology, cardiology, radiology, and whatever-else-ology. I thought the O&G rotation was busy, but by the looks of it, this rotation is going to be full-on. Goodbye, weekends.

In Retrospect: Bagan

2008-09-28T12:16:00.032+10:00

I had never heard of Bagan until I went to Myanmar (a.k.a. Burma) in February, 2004. It is THE place that gave Myanmar the nickname “The Land of Pagodas”. With thousands of temples and pagodas in various styles and sizes built between the 1000s and the 1200s while it was the capital of the Burmese Empire, Bagan exuded an air of otherworldliness. I stayed in Bagan for four days and explored on a rented bicycle the maze of dirt tracks connecting many of the pagodas scattered throughout the plains. It would take someone with a degree in archeology and Burmese history to fully understand the different styles and significance of the pagodas. Content with a simple description and explanation from my Lonely Planet guidebook for the major pagodas, I just enjoyed the artistry of the architecture and the relative isolation of the place. Pagoda fatigue notwithstanding, I relished the moments of watching sunsets while perched atop one of the taller pagodas, enjoying the delicious local food at roadside restaurants, and talking with the locals at juice stands and at the riverbank.

Sunrise from one of the smaller pagodas near my guesthouse

From the top of Shwesandaw, the countless pagodas dotting the now parched plains came into view. The lush vegetation would return when the monsoon came later in the year.

With very little vehicular traffic around, the trishaw was a cheap and efficient way for people to get around.

Vendors hawked souvenir at the more popular pagodas.

Shrines like this one, scaled to the appropriate size, are always found inside the pagodas.

This little kid sat with us at dinner.  He was wearing thanaka on his face like many children and women in Myanmar.

This lady at our guesthouse made thanaka by grinding a log of thanaka wood on a piece of stone.  Thanaka is worn as a cosmetic, sunscreen, and skin conditioner mostly by women and children.

With the cooling sensation of the freshly applied thanaka on my face and the drafty longyi tied around my hips, I was now ready for the oppressive heat of the dry season.

Lacquer ware was a famous local craft.

When parched from riding around the dry dirt tracks, a glass of freshly squeezed sugar cane juice was all you’d need.

Goats grazed in the shadows of the Ananda Temple.

Workmen repairing a sign in front of one of the pagodas

Ananda Temple, like many of others here, was still being used by the locals as a place of worship.

The afternoon sun streamed through a window inside the Ananda Temple.

This gilded statue of Buddha received many offerings from the locals.

Dinner consisted of rice with little dishes of delicious Burmese curries.

Sunsets were always magical in a setting like this.

The lifeline for much of Myanmar, the Irrawaddy River is a place where people do their daily bathing and washing.

Ride Up Mt. Coot-tha

2008-09-24T22:59:00.007+10:00

After a few days of doing not much more than turning pages of a book – I am reading Three Worlds Gone Mad by Robert Young Pelton – I am getting really restless. The weather isn’t all that great, but I will have to go outside and do something.

So I hop on my bike and head toward Mt. Coot-tha, a hill just west of the city center. It’s a good climb to the top at about three hundred meters in elevation. I breeze through the familiar bike path along the Brisbane River, go through a couple of suburbs, and start the steady climb at the six-kilometer mark, according to my cycling computer. The climb isn’t that steep, just enough to make you aware that you are doing a good cardio workout. After six kilometers and a three-hundred meter climb, I reach the observation point with a nice view of Brisbane and the surrounding suburbs.

This is what the city of Brisbane looks like today:

This is what it looked like in February, 2003, when I came to Brisbane as a backpacker:

That’s quite a few more tall buildings just in the span of five years.

All that hard work to come up only means an exhilarating coast back down. The road, devoid of any cars, is all mine. I lean forward with hands just touching the brakes, and let gravity pull me along the surface of the road at speeds up to 55 kmph. In just a couple of minutes, I am at the bottom of the hill, back to where I started. And I continue on my leisurely ride home along the river.

What a good work out. Now that I’ve worked up an appetite, I can’t wait for dinner.

Tonight’s dinner: that old standby during my college days - rice, black beans, and salsa. Except this time, the rice is not instant rice, the beans are cooked and not out of a can, and the salsa is not from a jar – I made that yesterday.

Full Moon Cake

2008-09-21T22:57:00.000+10:00

Around this time every year is the Mid-Autumn Festival in the Chinese culture. The exact date is the 15th of the eighth month – on the Chinese lunar calendar. So, just like Chinese New Year, that day shifts around every year, which means I have no idea when it is in any given year. All I know is that, for this year, the Festival has just passed. It still feels a little weird to have the Mid-Autumn Festival in the spring, but then again, it can’t be weirder than Christmas in the middle of summer.

The Mid-Autumn Festival, much like the Chinese New Year, is a time for families that have scattered all over the land to re-unite, feast together, and reinforce the familial bond. For families like ours in which one member of the family seems to move farther and farther away from home, that tradition has long ago died an unceremonious death, along with the family get-together during Chinese New Year, ancestral tomb sweeping during Qingming, and various other family activities that are, per tradition, spread throughout the lunar calendar year. Now we squeeze what activities we can into the couple of weeks every couple of years when my family actually gets together. During those couple of weeks, we’d make up for the reunions and family feasts we missed in the previous couple of years, visit the family grave plot, and do everything else completely out of season.

Okay, I am the guilty party in all of this. Whereas I used to be “only” at the other side of the country, now I am at the other side of the world from my family. My annual visits to my family are now taking place about every eighteen months. And now that, for several major reasons, I am planning on staying in Australia for good, we will have to make up for lost times every eighteen months or so. In the mean time, my mom will have to be content with my weekly phone calls.

Actually, the only reason I know that the Mid-Autumn Festival has passed was that, while picking up my ethnic grocery supplies at one of the Asian grocery stores in Chinatown today, I saw all those moon cakes on sale. I always have a soft spot for moon cakes, even though I can only eat about half of one before the sickly sweet cake becomes overwhelming.

This moon cake contains sweet red bean paste and a whole preserved duck egg yolk in the middle.

Happy Mid-Autumn Festival! Whenever that was.

Nine Down, Just One More To Go

2008-09-19T17:24:00.000+10:00

Yes, it’s done! The exams are over! Now I have a week off.

Hmm, I forgot to plan something for next week. I guess I’ll have to sit around, twiddle my thumbs, maybe read a book, have coffee with friends, do some bike riding, and generally do nothing.

Yeah, that sounds like a plan.

I want It Over Already!

2008-09-17T16:23:00.000+10:00

The rotation is coming to an end. Exams for this rotation are going to be in the next two days. I am at a point where the more I try to study, the more my knowledge seems to get all mixed up. All I am getting now is diminishing returns for my efforts. So, I am finished with studying. I’m going to put on a movie. Come on, exams, do your worst!

In Retrospect: Lhasa

2008-09-14T22:50:00.037+10:00

When I spent a month in Tibet in 2003, it was during a period of relative peace when ethnic tension between the Han Chinese and Tibetans was at a lull. There were no major anniversaries of any uprising or suppression or riots. So tourists were allowed to roam around Lhasa unimpeded.

I flew in from Chengdu and, being at 3700 meters from sea level for the first time, immediate got altitude sickness. My head was pounding non-stop; I lost my appetite, and had to gasp for air even by walking from my hostel room to the toilet down the hall. Through the first night, I constantly woke up gasping for air. On the second day, it took me half a day to get out of bed. I had some food and felt a little better. I regained my appetite quickly and was able to walk around soon after that, but the headache persisted for a whole week.

Much of Lhasa consisted of the drab utilitarian buildings found in every other Chinese city. The Tibetan Quarter, with buildings bearing the characteristic white-washed walls and crimson trim, had now been reduced to an area clustered around the venerated Jokhang Temple. I went out on three separate trips to see other parts of Tibet and came back to Lhasa to wash, rest, and plan the next trip.

On the flight from Chengdu to Lhasa, the Himalayas below looked unnervingly close to the plane.

The Potala Palace, once the seat of Tibetan theocracy, is now a museum.

The Chinese made sure that everyone knew who was in charge.

The gilded roof of the Potala Palace shined in the sun.

The concrete square just in front of the Potala Palace

The ruins of the buildings just within the Palace compound was a reminder of the destruction carried out in the city in the last fifty years.

Looking out from top of the imposing Potala Palace

View of the White Palace

~~~~~~~~~~

Jokhang Temple was built in the seventh century by King Songtsan Gampo to celebrate his marriage to the Chinese princess Wencheng.

Flower pots on the windowsill

Vendors line the plaza in front of Jokhang Temple, with Potala Palace in the background.

The Dharma wheel flanked by two deer, the symbol of Tibetan Buddhism, is placed at the top of every temple.

Decoration on one of the bronze bells at the top of Jokhang Temple

Pilgrims come from all over the land to prostrate themselves in front of Jokhang Temple, often for hours at a time.

The worn-out padding used by a pilgrim for her prostrations

Pilgrims, and some tourists, waited in line to enter the main temple.

Thousands of lamps fueled by yak butter gave the air a buttery scent.

The kora around Jokhang Temple also served as a market that sold religious paraphernalia.

~~~~~~~~~~

Sera Monastery, one of three great university monasteries of Tibet, is situated in the outskirts of Lhasa.

Crimson-robed monks participating in debates

Solar power at its finest

Norbulinka, just a couple of kilometers down the road from the Potala Palace, was the summer residence of the Dalai Lama when he ruled Tibet.

One of the buildings in the Norbulinka compound and its neglected yard

~~~~~~~~~~

The front gate of this house near the Norbulinka hints at the wealth of its inhabitants.

Trunks for sale

Always circumambulate a temple counterclockwise, and spin the prayer wheels in the same direction.

Just taking a rest

Playing chess on the sidewalk

I saw outside an electronics store this advertising poster featuring none other than Arnold himself touting a machine to help students learn a foreign language. Hmm, did Arnold use it to learn English?

The sleeper bus I boarded to leave Tibet

Ethical Minefield

2008-09-10T22:49:00.000+10:00

I visited an in vitro fertilization (IVF) clinic today as part of our OB/GYN rotation. I am aware of the debate around assisted fertility – Should people who are infertile for whatever reason be able to use technology to achieve pregnancy? Should the government allocate any resource for assisted fertility? Isn’t infertility natural selection in play – that people who are infertile are not meant to pass their genes to the next generation? Are we interfering with evolution by providing the means for those people to achieve pregnancy? – but with the IVF clinic visit, I came to realize a whole broadened range of ethical issues beyond the rationale behind the use of IVF.

Okay, this is an IVF clinic, the people working here and the patients probably all have looked past the ethical issues of using IVF. But IVF comes with a slew of new ethical issues. Each IVF cycle produces a number of embryos; the guideline allows only one to be implanted, so the rest of them are frozen for five years. After that, the couple needs to make a decision on what to do with them – keep them frozen for another five years or let them thaw (and die). What if a couple splits during that time? Does each parent have custody of half of the embryos? What if the father gives custody of all of the embryos to the mother? Will he still be liable for child support if the mother then decides to have a child using one of the embryos? Just when the law and guidelines are interpreted to provide a solution to a scenario, more what-ifs can come up, each one pushes the ethical and legal boundaries and contributes to the minefield that can potentially blow up in the faces of doctors and patients.

One of the doctors told us that, after working in the IVF for a while, he came to realize that everyone needs to come to terms with each ethical dilemma that may arise with every decision. On the issue of when life starts, he has come to the conclusion that life does not always start at conception. Like with natural conceptions where chromosomal abnormalities are the most common cause of first-trimester miscarriage, a good percentage of the eggs fertilized via IVF technology contain chromosomal abnormalities and thus not viable for implantation. Not all eggs and sperms are created equal and, due to de novo mutations, not all embryos are created equal. To someone who believes absolutely that life begins at conception, the number of embryos destroyed for that reason alone would make the place seem on par with abortion clinics, not to mention the thawing of all the frozen embryos. Clearly, one would have to become a moral relativist to be able to work in this field.

Bring Down the House

2008-09-04T22:45:00.003+10:00

Te, te Deum laudamus;
Te, te Dominum confitemur:
Te aeternum Patrem
omnis terra vene ratur.

For the last two weeks, I have been humming this opening phrase and other segments of Haydn’s Te Deum. They just form a loop, playing over and over in my head, whether I am reading, commuting, showering, sitting on the toilet, or even watching surgeries. Whenever I am not concentrating one hundred percent on what I am doing, this soundtrack wedges its way through to the front of my brain and starts the automatic loop. I must look like a lunatic on the bus sometimes, staring out the window with my head bobbing and feet tapping, but without the ubiquitous headphones sticking out of my ears.

I sing in the bass section of The Queensland Choir and, like what happens three or four times a year, it’s around concert time again. This time, we are doing Haydn’s Te Deum and Puccini’s Messa di Gloria. With rehearsals twice a week for a month before concerts and increasing familiarity with the music, it is inevitable that the music becomes a temporary fixture in the jumble of information swirling around my head. The music is beautiful and I really enjoy singing it, but having it played in a continuous loop can become a drag. Mercifully, I tend to be able to file it deep into the recesses of my mind after each concert so it does not become a nuisance.

Last Sunday we went down to Bangalow, New South Wales, just inland from Byron Bay, to do the Puccini piece to a full house. It was good to see in the audience a good number of dark spots in the sea of silvery white hair. I know, performances of classical music, with its formal, stiff-upper-lip settings, traditionally high-brow and inaccessible attitude, and strictly no interaction between the audience and performers and no improvisation, can hardly pose any threat to rock concerts. For our concert, we performed at a small Catholic cathedral with the audience filling every pew. With the warm afternoon glow streaming through the windows, we rocked the house. Well, as much as one can rock with classical music.

Our concert tomorrow will be in the Cathedral of St. Stephen in the middle of Brisbane. I am sure we will follow last weekend’s performance and bring down the house once again. What’s the music equivalent of “break a leg”? Strain a vocal cord?

Qui tollis peccata,
peccata mundi
suscipe deprecationem
deprecationem nostram…

In Retrospect: Grand Canyon National Park

2008-08-31T22:33:00.012+10:00

September, 2002: my first drive across the US. My sister and I went to Europe for a couple of weeks, then drove from Washington, DC, to Fresno, California. We crossed the Deep South and dodged a hurricane. In the last stretch of the two-week drive, we stopped at Grand Canyon in Arizona for two nights. The mornings and nights were chilly at that elevation, and early October meant the low season, so the crowds were small. We got up early to watch the sunrise, twice. We did little walks down the canyon, but didn’t go far.

The Grand Canyon is in the northwestern corner of Arizona.

Sunrise over Grand Canyon

It was a hazy day.  We learned from the Visitor Center that the westerly brought smog from Los Angeles to Grand Canyon from time to time.  Today was one of those days.  Thanks, Angelenos.

Standing at the precipice along the South Rim

The Abyss

The Canyon changed color as the day went by.  The setting sun gave everything an orange glow, despite the bluish haze.

The next day, we got up early again to watch the sunrise at a different spot.

Being at the top of the canyon, there is not much with which to frame the sunrise.  These couple of dead trees would have to do.

The haze from the day before was still hanging around.

Riverfire

2008-08-30T22:21:00.002+10:00

There is some kind of festival going on in South Bank. On schedule tonight is fireworks over the Brisbane River and a fighter jet from the Royal Australian Air Force doing some kind of dump and burn maneuver over the city. It happens every year; but I never bothered to go and watch it before.

But tonight, I strolled down to Kangaroo Point, found a spot with a good vantage point and not completely blocked by ten layers of people, and strapped my camera to the railing to take a few snaps.

Wooh, pretty fireworks.  Is it just me or is Brisbane’s skyline really bland?

Brisbane Bound

2008-08-22T22:20:00.000+10:00

Four weeks came and went in Hervey Bay. It has been busy but also very productive. I caught all four babies. The consultants and PHOs have been refreshingly nice to us and the teaching was excellent. So, I am leaving Hervey Bay feeling that the subject of obstetrics and gynecology is much more under control than four weeks ago. I don’t think I can expect clinicians in Brisbane to give me as much attention in the next four weeks.

Good bye, Hervey Bay. You have been good to me.

In Retrospect: Beijing

2008-08-17T21:32:00.038+10:00

After my first-year elective in Wenzhou, China, at the end of 2005, I made a little side trip to Beijing to visit a couple friends. It was around Christmas time and the sky was miraculously clear during my stay. The high-pressure system that rolled in from Siberia cleared the smoggy air, and the trade off was that it got COLD! For a couple of days, I was walking around in temperatures of minus six degrees Celsius as the daily high. Everyone burned coal for cooking and heating and so, almost everywhere I went, the sulfurous stench of burning coal hung in the air.

I dutifully hit some of the must-see places: Tian Tan, the Forbidden City, and the Great Wall. In the mean time, I filled up on the unassuming, hearty local fares, got lost in a few of the remaining Hutong on a rented bike, and sharpened my bargaining skills at the Silk Market.

A couple of policemen standing next to the entrance to Tian Tan, otherwise known as the Temple of Heaven. The main temple was closed for renovation, a recurring theme at many of tourist attractions during the low season.

The studded bright red gates opened to the causeway to the Hall of Prayer for Good Harvests in the distance.

This conjoined twins-like pavilion was a popular spot for locals to rest and exchange gossip.

View of one of the gates through holes of a cast iron urn.

Long corridors like this connect different temples inside Tian Tan Park. This one was the place where local retirees came to play chess, do their knitting, or practice their Peking opera.

Standing guard in front of Tiananmen Square under the watchful eyes of The Chairman

One of the smaller gates of Tiananmen

One of the pair of stone lions standing guard in front of the Hall of Supreme Harmony

Handles on one of the giant bronze urns placed throughout the Forbidden City. These urns were used for holding water to put out fires.

Blue Sky, Red Wall, Bronze Urn

Getting lost wandering around the maze of corridors is a guarantee. Each one of the 9999 rooms in the Forbidden City has its own history.

The low afternoon sun cast a shadow of the decorated roof ridge from an adjacent building on the wall of this one.

Reflections

The cracked paintjob on this heavy door was starting to show its age.

The sun was out, but it wasn’t working. I was wearing every item of clothing I had.

In the late afternoon, people started to stream down the long lane between two courtyards.

Leaving the Meridian Gate

~~~~~~~~~~

I did a 10k walk on the Great Wall from Jinshanling to Simatai. The terrain ranged from easy walk on flat and well-maintained sections of the wall to scrambling up vertigo-inducing steep and dilapidated sections.

Along the way, hawkers followed us and tried to sell us postcards and other souvenir. This being the dead of winter, farmers from villages along the wall took to selling trinkets for extra income.

Taking a break after one of the steep climbs

View through a window in a watch tower

The weak sun laid low on the southern sky the whole day, giving the brown hills and the wall a forlorn appearance.

A section of the wall that had not been rebuilt – not recently anyway

~~~~~~~~~~

I rented a bicycle and rode aimlessly along the maze of lanes through old neighborhoods that had not been torn down. Many of the hutong I saw were crumbling, damp, cold, and lacked plumbing. As much as we decry the demise of these traditional dwellings, I wouldn’t be surprised if the residents would prefer to live in bright high-rise apartments.

An elderly man pushing his cart down a lane, seemingly oblivious to the fast-changing world around him

Banana Vendor

Tiny eateries packed tightly together along a small lane. Many of them consisted of no more than a couple of small tables in the front room of a family’s home, but the food they served was cheap, delicious, and filling.

Brightly lit and frequented by the well-heeled, Wangfujing is one of the premier shopping centers in Beijing.

At Panjiayuan Market, Mao statues seemed to be one of the hot-ticket items.

Hutong Scene 1

Hutong Scene 2

This Muslim eatery, just down the block from my hostel, served delicious breakfast. The locals loved it too.

Drying Vegetables

Coal, the main fuel used by a lot of people living in hutong, was still distributed by people pedaling flatbed tricycles.

Oh, Baby Baby

2008-08-15T21:28:00.000+10:00

A major requirement for this rotation is that each student has to catch four babies. My experience with catching babies runs as deep as the one time when I helped out the midwife at a birth at the beginning of last year on my rural rotation. Unlike a lot of things in my medical training so far, like taking history and doing physical examination where we practiced over and over until we were blue in the face, we are stuck straight into it when it comes to delivering babies.

But I learned. The midwives were there to coach me on delivering the babies while coaching the mothers on breathing and pushing techniques. I realized that a major part of delivering babies, from the perspective of the midwife, med student, or doctor, is like cheer-leading, sans pom poms. When the contractions during the first stage become too painful for the mother, I offer her nitrous oxide and instruct her to breathe through each contraction. When the mother is exhausted and thinks she can’t push anymore, I follow the midwife and encourage her to push – with a calm voice. As one of the midwives put it, catching the baby in itself is the easy part. A lot of the work goes into what you do for the patient before and after the birth – anything from getting drinking water for the patient to wiping her bottom after a series of hard pushing, from helping the patient get into positions that might be a bit more comfortable to getting her warm blankets, it’s all part of the job. Of course, the medical side of things like taking her obs, documenting the progress of labor, and pain management has to be attended to constantly.

At the end of the day, seeing a healthy baby cooing in the arms of the exhausted but relieved new mother would bring a smile to anyone’s face, even if it’s two in the morning.

Done Deal

2008-08-12T21:24:00.000+10:00

I logged onto the Queensland Health website and there it is: two buttons. Accept – Decline. I slide the mouse cursor back and forth between the buttons.

Click.

Since Friday, I have been waiting to see if there is anything that tells me I should accept Queensland over New South Wales while all along, the nomad in me has been winning the argument. As far as the hospitals themselves are concerned, one is bigger than the other, but each has its advantages and disadvantages, so on that regard, it’s a wash. My gut feeling tells me to go for Wollongong. I know, it’s quite a big decision to make on gut feeling. It’s also a decision that may influence what road I go down in the future. Acting on gut feeling has served me well before; it has gotten me out of potentially sticky situations as well as steered me down the right path in the past. So once again, another major decision in my life is made.

The screen now reads “Logan Hospital: declined”.

Here I come, Wollongong.

Tape-Delayed Live Coverage

2008-08-09T21:17:00.001+10:00

Last night’s Olympics opening ceremony was really impressive. I know, I watched it live on TV.

So this morning I called my mom in California and asked her what she thought of it.

“Don’t know, we can’t watch it until tonight.”

“What? What do you mean?” I was incredulous. How on earth wouldn’t NBC broadcast it live like every other country on earth? “What about on the satellite dish?” I asked.

“No, couldn’t watch it. I even got up at 5 this morning [which would have been 8 pm Beijing time] and tried to see if it was on TV, but it wasn’t on, not even CCTV [the Chinese channel from mainland China].”

I went online to see why that would be. Wouldn’t you know it, NBC, which has the exclusive rights to broadcast the Games, had decided to delay showing the opening ceremony by twelve hours so it would be shown during prime time in the US.

Well, with the internet these days, people can just go online and watch it, right? Wrong! NBC has borrowed a page on information control from the Chinese government’s playbook. As this article on the New York Times described, NBC took down unauthorized videos of the ceremony from host servers and used geographic blocking technology to limit the best they could the number of videos that could be accessed from the US. The reason they cited was the $1 billion of advertising revenue at stake.

The Chinese government has gotten a bad rap for their internet censoring, their control of the flow of information for the purpose of maintaining political power. They have caught a lot of flak for it, and I think they should. But this is the first time I have heard of any organization in the West, be it governments or NGOs or corporations, so openly control the flow of information, albeit for a different purpose – commercial gains. Okay, the information at stake here is a show, not dissenting voice. But does it mean that it is okay to control the flow of information for commercial purposes, for profit? Is a corporation’s restriction on people’s access to information in order to gain commercial profit any more benign than a government’s restriction on access to information in order to maintain power?

I should have told my mom the little secret for accessing “unauthorized” websites I learned from local college students while I was traveling in China: proxy servers.

Decision 2008

2008-08-08T21:11:00.001+10:00

Queensland Health called me today and offered me a job for next year. It’s in a suburb between Brisbane and the Gold Coast.

Western Australia sent me an email – no deal.

South Australia: not a peep. No email, no phone call. I guess I should put them in the “No” column.

So now the choices for internship are between Logan, Queensland, and Wollongong, New South Wales.

On one shoulder, the nomad in me tells me to run with Wollongong: it’s time for a change of scenery. Brisbane is so four years ago. Go to a new and exciting place, make new friends, start a new life! Wollongong is only ninety kilometers south of Sydney, just think of all the culture you can access. The beach is within walking distance from the hospital. With all the national parks around the city, you won’t feel trapped.

On the other shoulder, the settler in me tells me: with Logan, you can live in Brisbane or the Gold Coast. The commute won’t be long either way. The move will be a piece of cake. You’ll be closer to your friends. The pay is better in Queensland. You’re already thirty-one, do you still really want to move around all the time? Is being able to fit all your worldly possession inside your car still something you want to boast about?

I think I will give the two of them some time to fight it out. I have until next Wednesday to decide on which position to take. Maybe I will have some kind of epiphany between now and then that will help me make a decision. Maybe.

In Retrospect: Paris

2008-08-03T22:48:00.031+10:00

I know, Paris, yawn.

Paris, the City of Light, the city that has been photographed to death, was not the most imaginative place I visited on my travels. It, however, was the first place I visited at the beginning of my two years of on-and-off nomadic life before medical school. The time was September 2002, when I had a few more dollars in my bank account, before the US dollar embarked on its spectacular nosedive, and before I had any real experience living out of a backpack. Armed with my first digital camera, a compact Minolta F100 point-and-shoot, my sister and I joined the throngs of other tourists and canvassed the tourist sites, photographing them at different times of the day.

Yes, the stereotypes were all true – the wine was cheap, the food was good, the portions were tiny, and the waiters were rude. We were told in no uncertain terms not to touch the oranges we wanted to buy at a street market, we were accosted by slick street salesmen at Montmartre, we almost became victims of a mugging in a Metro station. Yet even with all that, it was hard not to like Paris.

These pictures probably look familiar, that’s because there is not one inch of Paris that has not been photographed a million times. But these are special, they are MY pictures.

Street scene in the middle of Paris

Over a hundred years on, Hector Guimard’s timeless Art Nouveau metalwork still framed Paris’ Metro entrances ever so elegantly.

A detail shot of the front façade of the Cathedral of Notre Dame

Tourists’ hushed voices reverberated throughout the inside of Notre Dame

What an impressive combination of the chandelier and stained glass window!

Various saints flanked the spine of the roof

Gargoyles in different guises and poses guarded the cathedral against evil spirits.

View of the Pantheon from top of Notre Dame

A closer look at the Pantheon

Looking across the tranquil courtyard of the Great Mosque of Paris

Colorful ceramic mosaic covered the ground and walls

Another courtyard of the Mosque provided an oasis in the concrete jungle

Le Basilique du Sacre Coeur sat atop Montmartre

The columns at the top of Sacre Coeur framed the panoramic view of the city

I.M. Pei’s pyramids created a perfect counterpoint to the French Renaissance and Baroque architecture of the Louvre.

The main pyramid served as the entrance to the Louvre.

The cold, geometric steel and glass pyramid, set against the warm and ornate stone façade, all reflected in the pool in the still of the night.

Multi-lanes of traffic encircled the illuminated Arc de Triomphe.

We went round and round up the narrow spiral staircase to the top of the Arc.

From top of the Arc, looking down the brightly lit Les Champs-Elysees and over to the ever-present Eiffel Tower

Just imagine living in the shadows of the Eiffel

Light and music show from the Trocadero

Try not to strain your neck

Just had to pay homage to Jim Morrison

We didn’t even check the guide book to make sure that Versailles was open before we headed out there.  And sure enough, the palace ground was the only thing open the day we went.

So we had to make do with looking at the massive garden behind the palace.

A Different Demographic

2008-08-01T22:06:00.000+10:00

On my way to the hospital in the morning, I walk past the hospital sign. As per Queensland Health regulations, smoking is forbidden past the sign. So naturally that’s where clusters of smokers congregate, with a haze of smoke wafting around them or being blown into people’s faces as they walk by. One of the people leaning on the wooden stump is a young thin woman with a bulging abdomen, obviously pregnant. And yet, she’s puffing away without a care in the world.

I normally try not to be judgmental about people’s behaviors, even when there is a direct connection between their past or current behaviors and their subsequent illnesses. As long as they know the risks and are willing to take their chances, I am of the opinion that we, as health care professionals, are not there to save people from themselves. But when a woman becomes pregnant, it’s an entirely different story. All that individual freedom to choose what to do to their own body argument goes straight out the window, because it’s not about her body anymore. I am sure she has been educated about the dangers of smoking while pregnant. By knowingly allowing these toxic substances to circulate around her body, cross the placenta, and mix with the fetal circulation, what she is doing really amounts to child abuse.

~~~~~~~~~~

At antenatal clinics in the last few days, I saw quite a few pregnant women in their late teens coming in for check-ups. Some were on their first pregnancy, but some of them were on number two or three. I was told that it’s quite normal for young women to start having babies while in their teens in this area. The youth of these young expectant mothers were only rivaled by the young mothers I saw in rural Zambia. Such is life in rural Australia. While women in metropolitan areas focus on their careers and put off child rearing for later and later, women in rural areas run on a different clock, with a completely different set of priorities. I am not saying there’s anything wrong with having children so young, but to someone who grew up and live in the career-focused paradigm, seeing people who are content to start families as the first priority in their lives at such a young age is something that will take time to get used to.

Like they say, different strokes for different folks.

Back to Hervey Bay

2008-07-29T22:01:00.001+10:00

It’s the beginning of the second-to-last rotation: obstetrics and gynecology. I will be spending the first four weeks of the eight-week rotation back in my old haunt Hervey Bay.

The med school is putting me and another fourth year up in a house in a new subdivision just behind the hospital. Driving down the new road behind the hospital, I can’t help but notice that the neighborhood in front of me could have been airlifted straight out of Anywhere, USA, and plopped down in the middle of Australia. The same denuded landscape that had been clear cut to make way for cookie cutter houses, the same manicured lawns with feeble saplings propped up by supporting frames, the same deserted streets in which the only indication of human inhabitation are the cars parked in the driveway. The elegantly designed Queenslanders that are built and oriented to suit the warm and humid Queensland climate have given way to the cheaply and massed produced prefab homes. Another unique regional feature has died a quiet death by the forces of McDonaldization of the Western world.

This sterile neighborhood will be my home for the next four weeks.

In the morning, I walk over to Hervey Bay Hospital that had grown so familiar to me last year. Walking down the central corridor like I had countless times before, I keep running into junior and senior doctors who had taught me last year. To my surprise, they all recognize me and stop to chat. Sure, there were only ten of us here last year, so they didn’t have to deal with a thousand med students coming through day in day out. But stopping to chat with a lowly medical student? That’s way beyond what I’d expect big shot doctors would do. And yet, there I am, shooting the breeze with the head of surgery, being asked about my elective in Zambia by the consultant in medicine, listening to another surgeon recounting his OB/GYN rotation during medical school.

It’s nice to be back in Hervey Bay.

Book, Blanket, and Blues

2008-07-24T16:14:00.002+10:00

It’s been raining since last night. I woke up to the sound of a fine drizzle that seems to be here to stay, at least for the day. Gray, wet, and cold – not exactly the normal warm and dry winter days in Brisbane that I am used to. Now to think of it, it has been raining quite a bit lately, which is good for the water level of the reservoirs supplying Brisbane. We may actually see the loosening of water restriction at some point. But for me, being on my precious one-week break between rotations, the rain is a major bummer. I had originally planned to do a sixty-kilometer cycling trip to a couple of mountains nearby today. But the rain basically just killed that plan.

So I have to settle for the next best thing – brew a cup of hot tea, queue up some blues music on my computer, curl up in bed under a warm blanket, and read a book, one that has nothing to do with medicine.

~~~~~~~~~~

Today’s lunch: pita pockets filled with guacamole and sautéed chicken and mushrooms with a side salad.

A Day To Straddie

2008-07-22T22:06:00.008+10:00

As the alarm clock goes off at 5:30 a.m., I jump out of bed, eat a filling breakfast of muesli, and get ready for a full day ahead. Today my mate James and I are going to ride my bike to North Stradbroke Island, just off the coast from Brisbane’s eastern suburbs. It’s the southernmost of the chain of sand islands along the Queensland coast and the closest one to Brisbane. It will be a one-hundred-kilometer ride, roundtrip. I haven’t had a chance to do any serious riding since New Zealand back in January. The only riding I have been doing since then are the short commutes to and from the hospital and into the city, nothing more than a half-hour away, so this trip will be a good opportunity to give my legs a serious workout.

Google view of the ride from middle of Brisbane to Point Lookout on North Stradbroke Island

The ride starts near the hospital where I did the last couple of rotations. James and I start pedaling down the road just as the day breaks. The sky is veiled in a thin layer of clouds, the temperature cool enough to allow me a comfortable ride without breaking into a big sweat. Rush hour traffic on the other side of the road whizzes by toward the city. Following the thin line on the road that’s the designated cycling “lane,” we follow the undulating road from one suburb to the next. The thirty-kilometer ride to the ferry terminal in Cleveland is almost all on city road, save for a section in the middle where we manage to go on a parallel side road with less traffic.

Directions: from the corner of Ipswich Rd and O’Keefe St, go east on O’Keefe and continue onto Old Cleveland Rd. In Camp Hill, turn left on Wiles St, then right on Stanley Rd. At the T junction, take a right on Creek Rd, then immediately left on Meadowlands Rd. At the T junction, turn right on Belmont Rd, at the roundabout, turn left on Grassdale Rd. At the T junction, turn right on New Cleveland Rd, which ends on Old Cleveland Rd. Turn left and continue onto Finucane Rd. Finucane turns into Shore St West. Turn right on Passage St, then left on Middle St and the ferry terminal is straight ahead.

We arrive at the ferry terminal for the 8:00 a.m. barge with minutes to spare. The sun has burned away all the clouds in the sky. We sit on the upper deck, enjoying the warmth of the sun and the salty and cool breeze from the sea. The vehicle barge takes less than an hour to cross the calm water. As it docks at Dunwich, the tiny settlement on the western shore of North Stradbroke Island, we ride off the barge and head straight toward Point Lookout, twenty kilometers at the northeastern corner of the island. The road, narrow in parts, gently winds through the forest. In an hour, we arrive at Cylinder Beach.

The vehicle barge navigates the shallow channel to Straddie just ahead.

James takes in the view from the upper deck.

Waiting to disembark at Dunwich

Straddie is popular with Brisbanites on weekends and during school holidays, but being a weekday, the beach is deserted except for a few other groups of people. Still, a lifeguard has set up his yellow-and-red flags and is patrolling that section of the beach. After throwing a football around and jumping into the shallow water for a swim, we break out cooking kit for lunch. Doing this on the cheap, we brought our food for the day. After a nice feed, we go back on the beach. Lying down on the soft sand, I shield my face from the stinging sun with my cycling shirt. I don’t even remember when was the last time I spent a day at the beach doing nothing. What a great feeling! Soon I descend into a postprandial coma.

When I wake up, I look up to find ominous clouds blowing in from the north. The sun disappears, the whole beach becomes gray, and the air chills considerably. Looks like it’s nature’s way of telling us that it’s time to go. With legs properly rested, we hop back on our bikes and retrace our route back to Dunwich for the 4:30 p.m. ferry back to Cleveland.

Clouds start to roll in over Cylinder Beach.

By the time we get off the ferry, it’s almost completely dark. We put on the blinkers and pedal into the busy road. Although we are going against the rush hour traffic again, it’s not much fun riding in the dark. Some parts with no streetlights are dicey as cars pass within inches, while on the quieter roads we have to hope that there are no potholes to send us airborne. As we get closer to the city, my legs are starting to beg for mercy. Unrelenting, I push forward steadily at a slower pace. Back at where we started this morning, James and I head our separate ways.

At home, I cook up a dinner for four and eat it all by myself. After a nice hot shower, I crawl into bed, feeling every fiber of my legs screaming. Oh, it hurts, but it hurts so good; and not a bad way to spend a mid winter day.

Match, No Match

2008-07-21T23:03:00.002+10:00

Getting out of bed, the first thing I do is to check my email. Today is the day when every state releases their internship match results. New South Wales and Victoria put all of their applicants together, so I will hear from them today. Queensland, South Australia, and Western Australia will release the results for domestic students today; the riff raff like us international students will have to wait for a couple more weeks.

I am not too anxious about the results. A rumor has been floating around that New South Wales had more internship spots than they did applicants, which means everyone who applied would get a spot. If that’s true, I am fair confident about at least getting a spot somewhere. Chances are it will be somewhere outside of Brisbane, which is fine by me. After being based in Brisbane for three years, I am ready for a change of scenery. So I am very excited to fine out where I will potentially end up next year.

Being in the electronic age, that excitement of anticipation is somewhat dampened by the instantaneous access to information. Instead of checking the mail everyday for the arrival of the “fat envelope” – acceptance – and dreading the sight of the “skinny envelope” – rejection – like back in the day of college application, now I just go online and click on a few buttons. There’s no heft of the weighty brochure accompanying the acceptance letter or the flimsy one-page letter that flutter in your wave of disappointment. The results now just glare coldly back at you just the same, regardless of outcome.

With fingers flying over the keyboard, I log on to each website.

Victoria, the state with the most complicated application process, one that required the most effort from their applicants – no match.

New South Wales, with the easiest application requiring little more than demographical information on their online application – “Congratulations, you have been allocated to Network 11”. Woohoo! Where’s Network 11? A quick check reveals that it’s based in Wollongong, the third-largest city in New South Wales, just ninety kilometers south of Sydney.

Phew! I will have a job next year after all. Now I just have to sit and wait to see what kind of offers will come from Queensland, SA, and WA.

I walk out to check the mail at lunch time, and there it is – the fat envelop from New South Wales sticking out of the mailbox. Ah, the satisfying ripping open of the envelope, the reassurance of ink on paper. Thank you, NSW.

~~~~~~~~~~

Tonight’s dinner: vegetarian fettuccini with pumpkin sauce and grilled haloumi.

In Retrospect: Huang Shan

2008-07-20T00:43:00.021+10:00

I did my first-year elective in China in November 2005 and did a bit of whirlwind traveling afterwards. Huang Shan, or Yellow Mountain, in Anhui Province was one of the places I saw. It is also one of a few famous mountains in China not traditionally associated with Buddhism or Taoism. Consisting of a group of mountains, all of which are below two thousand meters, Huang Shan is not tall, but it is reputed to be the most beautiful of them all. Its scenery is considered archetypal of landscape beauty in traditional Chinese paintings. There’s a saying in Chinese, “After returning from a visit to the five major mountains [in China], one has no need to see any more mountains; after returning from a visit to Huang Shan, one has no need to see even the five major mountains.” So that’s how highly the Chinese have traditionally regarded Huang Shan.

To me, the climb up Huang Shan was just the perfect antidote to a month of living in a big polluted city in China. The clean air, lightly scented by the pine trees, combined with the greenery all around, made me feel like I was a million miles away from the pea soup I was breathing just a few days before. Despite the freezing temperature at night, I stayed at the top for two nights to explore the peaks on the network of stone trails.

Located in eastern China, Huang Shan is only a little over five hundred kilometers from Shanghai.

Jagged peaks and misty clouds are features of Huang Shan.

Climbing the concrete and stone steps is the ultimate Stairmaster.  All the supplies at the top are carried up on bamboo poles on the shoulders of porters like this one.  Tourists like me have the option of following their footsteps or going up in comfort in gondolas.

The luxury hotel at the top caters to groups of well-heeled tourists.  Penny-pinching backpackers can stay at the unheated but much cheaper guesthouse across the plaza.  There’s no question which one I picked.

The view across the peaks into the sea of clouds, just a five-minute walk from the guesthouse.

As evening approached, more clouds started to roll in to envelope the whole mountain.

The next morning, I woke up to find the whole place shrouded in dense fog. Well, bad timing on my part.  I walked around anyway, finding steps carved into rocks in places where the fog thinned out enough to see more than a few meters in front of me.

At a place where I could barely see five meters away, I came upon a rock where the water dripping down was the only sound around.  Click, click, click.

Dried leaves clinging on to the branches in the winter cold

This little creek near the guesthouse was frozen in place.

As the evening approached, the gnarled and twisting pine shrouded in dense fog added an eerie quality to the place.

The third morning, the fog receded, but mother nature didn’t give me one of the sunrises this mountain is famous for.

Walkways like this built into sheer cliffs allow people to see the Grand Canyon of Huang Shan.

View from one of the walkways over the “West Sea.”

These almost-vertical trails are not for the faint of hearts.

Taking a break, these sedan carriers had been desensitized to the breathtaking scenery around them.

Travel in style – being carried around in a sedan on a mountain

The "Welcome Pine", the symbol of Huang Shan, is probably as famous to the Chinese as the General Grant sequoia tree is to Americans.

It’s difficult to go straight down while trying not to lose your footing by getting distracted by the scenery.

Everywhere you turn, there are pine trees taking a foothold on craggy rocks like this one.

Eight Down, Two To Go

2008-07-18T21:40:00.000+10:00

Yay, it’s the end of another rotation. This rotation, without an exam at the end, more or less fizzled out rather than having a “proper” end, which is just fine. Now I’m looking at the two hardest rotations for the next four months: obstetrics and gynecology, and pediatrics. In comparison, the first three rotations of this year were mere holidays.

I will be enjoying the break next week nonetheless. This is the first break since starting of third year when I don’t have anything planned. No camping trips, no going anywhere. I will be hanging around Brisbane, with maybe a day trip here and there. But it will be a good and relaxing break before I have to buckle down for the next four months.

~~~~~~~~~~

Tonight’s dinner: wonton noodle soup. Yes, that’s a sauce pan. And yes, it’s just for me, myself, and I. Oink.

You Don't Look Like An American

2008-07-10T22:38:00.000+10:00

At the eye clinic today, an elderly patient in her seventies came in with her daughter for a follow up review. At the end, she turned to me and asked, “Where are you from?”

“The United States,” I answered.

Clearly surprised, she pulled her head back and squinted, “Oh, you don’t look like an American.”

With just a flicker of annoyance on my face, I thought to myself, “What do you mean, lady? Which part of me doesn’t look American?”

Her daughter, barely concealing her embarrassment, tried to make a joke to divert our attention from the awkwardness hanging in the air.

Completely oblivious, she continued, “Where are your parents from?”

Ah, so it’s the non-white part of me that doesn’t look American. “I’m Chinese,” I offered.

“Ha! I was born in Formosa.”

“Oh, okay. That’s Taiwan.” I added without missing a beat.

Clearly surprised again and now very impressed, she said, “Very good. A lot of Chinese people I ask don’t know where Formosa is. My parents were Russian and I was born in Formosa.”

Welcome to the twenty-first century, lady. Nobody’s been referring to Taiwan as Formosa for like a hundred years. I said, “Well, I do know a bit of geography.”

With that, the patient’s daughter said, “Mum, we should be going,” and whisked her out of the consult room.

I guess she will always call Taiwan “Formosa” until the day she dies because that was the name she had first learned, even when the native name is universally accepted and doesn’t carry with it any colonial baggage. It was like when I came back to Australia back in March and told people I just came back from Zambia. Quite a few of the people in their sixties or older either stared at me blankly or asked straight up, “What was its name during colonial times?” When I said, “It used to be Northern Rhodesia,” I could see the light bulb light up over their heads. The country has been independent for over forty years and you still only know it by its colonial name?

In Retrospect: Purnululu National Park

2008-07-06T12:22:00.016+10:00

The first time I came to Australia, I backpacked around the country for four months. I went through Purnululu National Park in Western Australia on my way from Broome to Darwin through what’s considered the final frontier of Australia: the Kimberley. It was May, 2003, in the early part of the dry season in this tropical part of the country. Days were dry and hot and the rain had already stopped for a few weeks – perfect for hikes and camping under the open sky.

Purnululu National Park is located in the Top End in tropical Australia.

The place is also called Bungle Bungle. The national park was declared a UNESCO World Heritage Area in 2003.

The national park is famous for its sandstone domes with alternating orange and gray stripes.

We arrive at the park in the late afternoon. I took a helicopter flight over the Bungle Bungle Range.

View over the range into the Northern Territory

Our chopper pilot-cum-tour guide gave us a running commentary as we flew over different parts of the park.

The setting sun cast a warm glow over the unique sandstone domes.

Watering holes were starting to dry up in the dry season.

Taking a hike among the domes

A couple of fellow backpackers were admiring the smooth craters created by rushing water during the wet season.

Termite mounds like this littered the landscape. Don’t imagine it to be a good place for building houses.

The tall but thin mini palms growing against the backdrop of rough sandstone rocks

Behind this grove of mini palms is a little pond called Froggy Pool, due to an abundance of tiny frogs that rely on the pool.

A Stimulating Job

2008-06-27T22:15:00.001+10:00

The patient, with a metal frame screwed onto his head like a crown, is being pulled out of the CT machine and transferred to the operating theater upstairs. He is about to undergo a radical surgery that holds the promise to control one part of his Parkinson’s Disease.

I am rotating through neurosurgery for two weeks. Besides the standard ward rounds and outpatient clinics, I get to watch in theater as surgeons tinker with that most delicate part of the body – the brain and spinal cord. This patient being wheeled into theater has been suffering from Parkinson’s Disease for twenty years and his worsening tremor has become refractory to medical treatment. The radical surgery, only the fifth to be performed at this hospital, will put electrodes into the part of the brain affected by the disease. The probe is then connected to a “pacemaker for the brain.” When switched on, the patient’s tremor will be dampened to such a degree that he will regain normal function of his hands and arms.

In theater, the surgeons gain access to the patient’s brain by cutting loose a piece of his skull. In order to find the right part of the brain to implant the electrodes, the surgeons need to talk to the patient. So, after all the instruments are in place, the anesthetist brings the patient up from anesthesia. Under an infusion of sedative and analgesia, the patient answers questions from the surgeon, shows his tremor by reaching for an object. One of the surgeons carries a conversation with the patient while another pulls the probe out ever so slightly. With a few slight adjustments of the probe, the patient’s tremor is noticeably reduced. It’s quite a sight: a team of surgeons and nurses surround the patient, whose head, with part of the skull flipped open, is bolted to a metal frame that is attached to the surgical bed. The patient calmly answers questions from the surgeons and obeys all the commands, seemingly oblivious to all the work going on inside his head.

After about six hours, the surgery comes to an end. Soon, the patient will be able to wave a little device in front of his chest to turn on the stimulator and, just like that, his tremor will be stopped. Isn’t that awesome?

Job Hunting

2008-06-25T22:40:00.000+10:00

Last weekend marked the exact halfway point of this year. We are less than six months from graduating. Everyone is talking about where they are putting their preferences for next year – it’s the Queensland version of The Match.

Queensland Health, the state government agency that runs all the public hospitals, employs all the interns in the state. Anyone graduating from a medical school in Queensland who is an Australian citizen is guaranteed an internship spot in the state. They just have to work out how to distribute the spots throughout the state to those students. It’s a pretty sweet deal for them.

As an international student, I unfortunately am not guaranteed a spot. So, to up my chances of getting a job next year, I decided to apply all over the country. As I filed my last application – to Queensland – the hardest part of the game began: sit back and wait. All the states are announcing the match results at around the same time in late July.

I really don’t care where I end up next year, as long as I get a spot somewhere in the country. I could be staying in Queensland but somewhere up the coast. I could be down in New South Wales, living large in the big smoke. I could be in country Victoria, freezing my ass off in the winter. I could be in South Australia with its famous wineries. Or I could be in Western Australia, chilling out in the vibrant twin cities of Perth and Fremantle.

Ah, the possibilities, the sense of uncertainty. Soon enough, I will have to make a choice that will take me to the next phase of my life; or the choice will have already been made for me. I can’t wait; this is nail-bitingly exciting!

In Retrospect: Angkor Wat

2008-06-22T23:33:00.001+10:00

In December 2005, after finishing my first-year elective in China, I went for a little wander around Southeast Asia. Although it was a bit of a whirlwind trip, I did have a three-day visit to Angkor Wat in Cambodia. The sheer number of temples and pagodas in and around Angkor Wat made for an overwhelming experience; after just half a day, one temple started to blend into the next pagoda. Each with its history and religious significance, the temples could be appreciated at so many levels, whether from the perspective of history, or religion, or art, or even anthropology. Though now a Buddhist temple, Angkor Wat was originally built as a Hindu shrine.

Angkor Wat is located in the northwest of Cambodia seven kilometers north of the modern town of Siem Reap, which means “Siam Defeated” in Khmer.

The ubiquitous tuk-tuk takes tourists around Siem Reap.

View of the sunset from top of Bakheng

From the top of Bahkeng, glimpses of Angkor Wat can be had amidst the lush jungle

The west-facing Angkor Wat silhouetted against the morning sky

Busloads of tourists visit Angkor Wat each day

Bas-relief on the western gallery depicting scenes from the Hindu epic the Ramayana

Bas-relief depicting soldiers with shields

Riding on a hot air balloon is one way to see it

Another bas-relief depicting the monkey king

Two locals tending to a shrine in the inner temple

View from top of the inner temple

Children playing around the inner temple

A family rests in the inner temple

Intricate carvings adorn the façade

A saffron-robed monk taking a break

A tour guide waits for his group to return

Statues outside the south gate to Angkor Thom

The crumbling south gate to Angkor Thom

One of the many faces of the Bayon in Angkor Thom

Angkor Thom is the setting for many products in Western popular culture, from video games to novels to movies.

The moss-covered statues and shifted stone blocks add to the eerie feel of the Bayon

The slight smile of the faces on the Bayon is like the Buddhist version of the Mona Lisa.

When walking at the top level of the Bayon, one constantly sees the enigmatic smile of the Bodhisattva from every direction.

The exquisite Banteay Srey, located twenty kilometers north of Angkor, is a must see for anyone in the area.

The unworldly level of sharpness and detail in the artistry of the carving on the Banteay Srey is beautifully preserved.

An artist sketching at Ta Prohm, among the most famous of the temples at Angkor

Tomb Raider, anyone?

The root of a silk cotton tree runs along the gallery of the second enclosure.

Another part of the temple almost completely consumed by the jungle

A monk returning from the morning alms-receiving

ER, In Reality

2008-06-14T23:06:00.000+10:00

Emergency medicine, the branch of medicine soaked in adrenaline, as is so often dramatized on various TV shows, is in reality much more subdued and mundane. With so many patients coming in with little cuts and coughs and general non-emergencies, you’d actually hope for the chaos as depicted in ER.

So, in search of some excitement, I took up the recommendation by the head nurse and did an overnight shift last night. Friday night is normally referred to as “suture night” due to the hordes of drunken people getting into fights and cutting themselves on various sharp and not-so-sharp objects. And more drunken people also mean more car crashes. So I put on my white coat – medical students are required to wear a white coat in the emergency department so we are easily identified, none of the real doctors wears one. Ironic, isn’t it? – and headed to emergency at 10 p.m. on a Friday night.

“That’s really sad – it’s Friday night and you’re here,” was the first thing the consultant told me as I introduced myself. Okay, so no acknowledgement that a medical student was sacrificing his Friday night in the name of learning. Fine, I am a loser with nothing else better to do than studying on a Friday night. So be it.

The night didn’t hold much promise, as it turned out. Customers trickled in with falls and chest pains that turned out to be nothing major. A couple of category 2 calls to the resuscitation bays were also non-events. Two o’clock rolled around, I stood in front of the list of patients waiting outside, trying to pick one to see. “Cat 2 resus 4,” the overhead speakers crackled. I walked over to the resuscitation bay to investigate. “Eighteen-year-old female was stabbed at a party,” the paramedic announced. While the doctors were assessing her, I volunteered to put in a cannula in the patient’s arm. She was a thin young girl, her veins were probably tiny. I wanted a challenge and see if I could put in a big cannula in a difficult patient. Stabbing victims could lose a lot of blood, so large bore cannulas are often necessary. I flipped her arm over and a big fat vein just stared at me in the face. Ha! Too easy! I grabbed the eighteen-gauge cannula and quickly shoved it into the vein while she was talking to the doctor.

While checking her over for serious bleeds and finding none, the noise of someone screaming obscenities on top of his lungs pierced the hushed air. Five security guards were holding a young man down on the trolley. It turned out that he was one of the patients in the secured unit where prisoners are treated. The doctors on duty turned their attention to him and tried to find out why he was so agitated. They maneuvered him into a room and closed the door. Cursing and the noise of the patient thrashing around easily penetrated the thin walls. After twenty minutes or so, the patient wore himself out and decided to stop.

So that was as close to drama as the emergency department got last night. Maybe I was unlucky to have picked last night to come in, or maybe people in the southside of Brisbane were extra lucky last night. I guess I should be glad that nothing major happened, for the people’s sake.

At around 4:30 a.m., as the emergency department went back to a lull, I was told that I should go home.

In Retrospect: Jiuzhaigou National Park

2008-06-08T22:45:00.024+10:00

The devastating earthquake in Sichuan Province in China last month is a reminder that the province straddles one of the world’s most active quake zones. But precisely due to this geologic activity, the province is home to ranges of soaring mountains and unrivalled natural beauty. I went to Jiuzhaigou National Park in October 2003 during my month-long stay in Sichuan.

The name Jiuzhaigou, pronounced ‘joo-JAI-goh’, means Nine-Village Valley; the nine villages are inhabited by the local Tibetan and Qiang minorities. It is in a notoriously difficult to access part of the province. The bus ride, on roads with thousand-meter drops on one side, was in itself a harrowing experience. The couple of upside-down buses on the side of the road, like tipped over giant turtles, didn’t exactly instill confidence. But the breathtaking scenery was well worth the risk.

Jiuzhaigou is situated in northern Sichuan province.

A stream close to the park entrance

The trees along the stream provided a preview of the fall foliage deep on display inside the park.

As 99.9% of the visitors took the shuttle bus, I had the broad plank walkway all to myself.

The water was so clear, it was difficult to gauge the depth of the pond.

Taking a break next to a little cascading waterfall

A Tibetan village is nestled between the foothills and the creek at the bottom of the valley.

The creek widens into small lakes in parts of the valley.

The turquoise water contrasts against the riot of fall foliage around it.

Another view from the plank walkway. The newly-built road for the shuttle bus is at the opposite side of the creek.

Another gem of a little lake

Nourilang Falls is the signature location of Jiuzhaigou. It’s not particularly tall or wide, but definitely photogenic.

A walkway built at the bottom of the falls allows people to take in the view head-on.

Like the name suggests, Mirror Lake does a perfect reflection of the surrounding mountains.

Five Flower Lake is home to a strange scaleless fish.

Five Color Lake is one of the most popular spots in the park. Its nutrient-rich water supports different types of plants, giving the water different shades of the green-blue spectrum.

Another view of Five Color Lake

A popular photo spot for tourists on the bank of Five Color Lake

Pearl Shoal, with a moss-covered bottom, is part creek, part cascading falls.

Sunlight reflected off the clear water created colorful ripples.

Long Lake is the highest and deepest lake in the valley. The clouds gathering behind the mountain gave it a menacing alpine feel.

A flurry is starting to cover the mountains around Long Lake.

Sleepy Times

2008-06-06T22:45:00.001+10:00

Before starting the anesthetics term, I didn’t think I would be that interested in the specialty. But it’s actually a very interesting field. For starters, there are a lot of procedure-based work: cannulas for everyone, bagging patients, intubation, arterial lines, spinal blocks, the list goes on. There are short procedures where the anesthetist needs to take care of the patient for only fifteen minutes, and the there are major surgeries that go for hours and hours. For those long surgeries, the fun and danger are at the beginning and the end – it’s kind of like flying a plane. All the checks and prep work at the beginning are there to make sure everything goes smoothly. Then when the actual surgery starts, the anesthetist can basically hit autopilot and read a book or something. If all the work at the beginning is good, it’s pretty much smooth sailing until the surgery is finished. Then at the end it’s like landing a plane where the pilot has the highest chance of getting into trouble. Most of the time it’s uneventful, but when things go wrong, they have the potential to go very wrong.

I also like the relative straightforwardness of the work involved. The anesthetist has a small number of powerful drugs to play with: a little of this for sedation, a little bit of the white stuff to put the patient to sleep, something clear for pain, a little of this to paralyze them, twist that knob if they are not quite asleep. Of course, it’s more complicated than that, otherwise they wouldn’t need to spend five year in a training program. But only after a week, I feel like I can get the hang of things quite well and actually enjoy it if I get into anesthetics, which I can’t say for some of the other specialties.

So, anesthetics just came out of nowhere and nudged its way for a place among the top of my list of potential careers. Cool.

ICU

2008-05-30T22:45:00.000+10:00

The patient is lying on the bed motionless save for the rhythmic rise and fall of his chest, with tubes coming out of every natural orifice and a few from surgically-created ones. All around him are monitors displaying colorful squiggly lines and flashing buttons. With lines put into various parts of the patient’s body – artery, vein, brain – wires connected to other parts – finger, chest – and tubes down yet other parts – trachea, bladder – the patient’s every physiological change is on display. The intensive care unit is where medicine goes high-tech. It’s the playground of control freaks. Armed with a suite of electronic and pharmaceutical arsenal, the ICU doctor can fine tune the mechanics of each patient’s physiological function.

Among the patients that take up residence in ICU, quite a few are accident victims. Pedestrian vs. car, motorcycle vs. truck, cyclist vs. truck, car vs. tree, car vs. car – those are the descriptions given to each of the mostly young patients, as if they had foolishly engaged in a physical altercation with their respective adversary. Their multiple fractures, ruptured internal organs, and brain injuries had instantly transformed their lives. Multiple operations to fix the fractures, remove the ruptured organs, or generally put the patient back to one piece as much as possible are just the beginning of a lengthy recovery process – that’s if they survive – with deficits of normal function to varying degrees. You can consider that either lucky or unlucky, depending on your outlook on life.

New Rotation

2008-05-26T22:45:00.000+10:00

Just as fast as it started, the break is over and another rotation is upon us – specialties 2. This rotation includes critical care – intensive care unit, anesthetics, and emergency – and the specialties of neurosurgery and ophthalmology. That’s quite a good number of specialties packed into eight weeks. They are more procedure- and surgery-oriented, which, to me, is more interesting.

I am looking forward to it.

Hinchinbrook

2008-05-25T21:44:00.065+10:00

Hinchinbrook is about half way between Townsville and Cairns in north Queensland

Day 1: Brisbane to Cardwell

It’s 5 a.m., the four of us, Anderson, Pam, Richard, and I, are on our way to the airport for our early morning flight from Brisbane to Townsville. While none of us is a morning person, Pam is having an especially rough time. She had stumbled back at 4 a.m., after a long night of partying to celebrate the end of a rotation. And now the three of us are dragging her, drunk and delirious, through check-in and onto the plane. Two hours later, we land in Townsville.

After picking up some fuel for camping and having a leisurely breakfast, Pam is starting to sober up. We head for the train station for the train up to Cardwell, where the ferry leaves for Hinchinbrook.

Upon boarding the train, we are all pleasantly surprised at how comfortable it is: wide plush seats with a TV for each seat, the train travels so smoothly we can hardly feel it moving. After hanging out at the dining car for a while and watching the scenery go by, we are lulled to a sleep by the slight rocking rhythm of the moving train.

Pam is sober and is on her way to a sugar high

Richard and Anderson are finding something funny

Two-and-half hours later, we arrive at the tiny town of Cardwell. After settling in at a backpacker’s hostel and getting some last-minute groceries for the walk, we spend the rest of the afternoon walking along the beach and generally enjoying the sun.

Day 2: from boat to trail – walk to Nina Bay, 5 km

In the morning, the sun is shining with not a cloud in the sky. It’s going to be a good day for walking. In mid-morning, we are picked up by the minivan to take us to the harbor where the ferry leaves. A hour later, after a quick stop at the resort on the island, we get dropped off at one of the creeks where the walking trail starts. The boardwalk to the beach is closed for maintenance, so the trail starts from a different creek and adds another hour to the walk. Although our packs are at their heaviest, we are all fresh and our steps are light.

Between Richard, Pam, and Anderson, there are three bum knees and one previous ruptured Achilles tendon. Ironically, being the oldest one in the group, I am the only one without any previous musculoskeletal injury. The Thorsborne Trail, deceptively short at only thirty-two kilometers in length, is considered a difficulty one due to the terrain. Rock hopping, swamp wading, creek crossing are all part of the deal. While they may not be that difficult on their own, put twenty-five kilos of pack on your back and the challenge is not hard to appreciate. So we will take it slow.

Looking back at Port Hinchinbrook as the ferry pulls away

Jagged peaks form the skyline of Hinchinbrook

Our party of four: still smelling fresh, our clothes still clean, and our muscles still loose

The ferry cruises up one of the creeks lined with mangroves. Mt Bowen looms in the distance.

The temporary disembarkation site: just a couple of planks tied to mangrove roots, an apt introduction to the walk.

Walking down Ramsay Bay

We want to have lunch at a place with a view, so we walk to up Nina Peak via a side trail. At 312 meters elevation, Nina Peak offers spectacular views of the Island, with Ramsay Bay and the numerous channels to the north and Nina Bay, Little Ramsay Bay, and Zoe Bay to the east and south. After a few reconnaissance missions, we find a rock ledge in the shade, perfect as our lunch spot. One by one, we slide up the ledge. With our feet hanging over the edge and a couple of hundred meters sheer drop just inches away, we start making our lunch of salami and cheese wrap. Away from the midday sun, with an awesome view of the bays to the south, Mt Bowen directly to the west and sheer rock directly under us, it’s hard to imagine a better place to have lunch.

Richard, Anderson, and Pam taking a break

View of Ramsay Bay and the channels snaking their way into the island

Lunch spot with Mt Bowen in the background

The view from our lunch spot

After lunch, we reluctantly leave our awesome lunch spot and head back down to the trail. An hour or so later, we arrive at our camp site at Nina Bay. The hammock I got for my cycling trip in New Zealand comes in handy again. I string up my hammock while the other guys pitch their tents right on the beach.

Hammock is the way to go, as long as there are trees to string one up.

At night, we cook a filling meal of instant soup, followed by rice with curry, then tea with roasting marshmallow over an open fire. We sit on the beach under the full moon, chatting away until late and not worrying about disturbing anyone – we are the only group at this campsite for the night.

Day 3: Nina Bay to Little Ramsay Bay, 2.5 km

After a good night of rest, we get up as the sun comes over the horizon. After some hot tea to warm ourselves up, we have a yoga session led by Pam the Yogi right on the beach.

The sun peeks over the Coral Sea

Anderson staring at the rising sun

I need to work on my warrior pose

After a leisurely breakfast and getting our water bladders filled, we set off for a short walk to Little Ramsay Bay.

Anderson says, “Let’s get crackin’!”

View of Nina Bay from the rocky headlands

Richard picks his way through the pile of rocks at Boulder Bay

We arrive at Little Ramsay Bay before lunch time. After setting up camp and eating another lunch of salami and cheese wrap, we head to the lagoon for a quick dip.

Anderson walks down Little Ramsay Bay toward the campsite amongst the bush

Pam is out cold in the hammock

Day 4: Little Ramsay Bay to Zoe Bay: 10.5 km

We wake up to another day of beautiful weather. Today is the longest walking day, so after a quick breakfast, we pack up camp and head off towards Zoe Bay, 10.5 kilometers to the south. En route, we will climb over rocks, cross a couple of swamps and creeks.

The lagoon at Little Ramsay Bay in the morning with Mt Bowen dominating the skyline

Anderson and Pam gathering water before the day’s long hike

The beach at Little Ramsay Bay ends at this pile of rocks we have to climb over

The view north from the rocky headland

Walking sticks are essential for this trail

We are standing at the saddle between Banksia Bay and Zoe Bay. Zoe Bay is the sliver of blue at the base of the mountain in the distance.

Crossing one swamp with slippery tree roots

Crossing North Zoe Creek. The water may not be deep, but the rocks are very smooth and slippery.

Crossing a palm swamp with ankle-deep mud. A couple of days ago someone fell while hopping from tree root to tree root. He ruptured his Achilles tendon and had to be airlifted out. So, be very careful and just step right into the mud. Better be dirty than be hurt.

We pass another mangrove swamp, which is dry enough that we can walk around it.

With another hour of sunlight to spare, we arrive at the campsite at Zoe Bay. A sign warns us of the crocodiles active in this area. After dinner, we set up another fire on the beach damp from dews. The temperature is dropping more than previous nights. We huddle around the fire, drying our boots and socks that were completely soaked from earlier in the day, and chat late into the night.

We collect our drinking water from South Zoe Creek, just downstream from Zoe Falls.

South Zoe Creek in at dusk, with the sounds of rushing water and chirping birds, is quite the tranquil place to be.

Day 5: Zoe Bay to upper Zoe Falls: 1 km

Today’s goal is to walk to Sunken Reef Bay, with a stop at the base of Zoe Falls.

The dampness on the beach evaporates as the sun comes up over Zoe Bay

The sound of Zoe Falls gets louder and louder as we walk up along South Zoe Creek. As we round a bend on the trail, the waterfall comes in full view. What a welcoming sight: a natural rock pool at the bottom of the cascading falls with crystal clear water flowing through. Add the bright sun and blue sky, we can spend all day here!

The picture-perfect Zoe Falls

After a little asthma attack, Pam makes it to the bottom of the falls and is rewarded with the best water massage.

After the invigorating swim and water massage, we sit on the rocks to admire the view. Eventually, we decide that we would have to make a move if we were to make it to camp before nightfall. Reluctantly, we put our packs back on and follow the trail up to the top of Zoe Falls.

Anderson pulls himself up on this steep section

A ten-minute walk takes us to the top of Zoe Falls. Zoe Falls may be nice, but the view up here is amazing! We look around, and come to the simultaneous conclusion that we have done enough walking today. We will set up camp here and spend the whole afternoon on these rocks. The water has carved numerous tubs into the rocks. We decide this is our spa day. Jump into this one for a soak, get into the next one for a shoulder massage, lay on the warm rocks to dry out, back to step one and repeat as needed. This is the best decision we have made.

With a view like this, it’s hard to keep moving.

Just whiling away the afternoon

Richard is enjoying a world-class shoulder massage.

Another view of the pools with Zoe Bay in the distance

In the late afternoon, I go back to the bottom of Zoe Falls to take more pictures of the creek.

Zoe Falls at dusk

The low-light condition at dusk is perfect for taking pictures of moving water.

At night, we set up our stoves on the warm rocks and cook up another satisfying meal of mapo tofu over rice.

Day 6: upper Zoe Falls to Mulligan Falls: 6.5 km

In the morning, clouds start to roll in from the east. It looks like rain is a definite possibility today. We will skip Sunken Reef Bay and head straight to Mulligan Falls.

Breakfast on the rocks

Rich and Pam negotiating their way down rocky steps

As we stop for lunch, rain starts to come down. Although it passes quickly, the trail is quite slippery now. After a quick break, we press on.

From this point, the mainland to the south is visible, with the long jetty from Lucinda cutting across the water.

The rain makes everything that much greener

Walking past the side trail leading to Sunken Reef Bay, we come upon the mighty Diamantina Creek. These creeks can swell up fast after the rain and signs are there to warn walkers of the danger of crossing one right after the rain. We check the condition of the creek and the water level on the rocks and decide to cross. With every rock carefully selected for foot hold and every step carefully tested, the going is slow.

Contemplating the creek crossing

Following the arrows on the rocks, we start to cross the creek.

It may look like a tranquil picture, but the rocks are very slippery, especially after the rain.

After crossing Diamantina Creek, it’s only another half-hour to the Mulligan Falls campsite. We set up camp, and it’s time for another swim. Despite the overcast sky and slightly cooler temperature, the swim is still refreshing.

Waterfall and rockpool, the winning combination

Mulligan Falls at dusk

As we finish dinner, rain comes down again. We abandon our gear on the ground and quickly get into our tents. Swinging in my hammock, dry and toasty in my sleeping bag, I am soon fast asleep as the rain hits the rainfly just above me.

Day 7: Mulligan Falls to George Point: 7.5 km

Sadly, this is our last day on the island. The rain has stopped. We eat a leisurely breakfast while waiting for things to dry out a bit. All we have to do is walk to George Point 7.5 kilometers away, most of it along the beach. Easy day.

We gather around the spread of water bottles and stove for breakfast. Our packs and food are hung up on ropes to prevent the native rats from getting to them.

The walk out to the beach takes us through a forest reminiscent of Lord of the Rings country, with sprawling tree roots winding among rocks.

The walk on the beach is so easy compared to the rest of the trail, it almost gets a little boring. With our shoes off, we wander down towards George Point. Without having to worry about where to put the next step, all there is to do is to listen to the waves on the left and admire the cloud-covered peaks on the right.

Crossing Mulligan Creek with Mt Straloch in the background

The ragtag army strolls down the beach

We made it to George Point!

From George Point, another boat takes us back to the mainland. And our walk on Hinchinbrook comes to an end.

Looking back at Hinchinbrook from the boat to Lucinda

From Lucinda, a minibus takes us back to Cardwell. We check back into the backpacker’s. First order of business is showers! Throwing on some semi-clean clothes, we celebrate the completion of an awesome walk.

Cheers!

Day 8: Cardwell, Cairns, and back to Brisbane

To get back to Brisbane, we catch a bus from Cardwell to Cairns, 180 kilometers to the north. After an afternoon of walking around the tourist district of Cairns, we catch a late-afternoon flight back to Brisbane.

Our trip comes to an end. This may be the last time in a long time that the four of us would be able to make a trip like this. In six months, we will graduate from med school and will head our separate ways; and we may be scattered all over the world.

But guys, remember what I mentioned on the trail – cycling the Silk Road, 2012.

Seven Down, Three to Go

2008-05-16T18:43:00.001+10:00

The exam this afternoon marks the end of specialties 1 rotation, which means a one-week break is coming up.

It has only been eight weeks since I’ve been back in Brisbane, but I am already getting itchy feet. So three of my friends and I will be taking off for a week of camping on Hinchinbrook Island National Park in tropical north Queensland where Nim’s Island was filmed. The walk on Hinchinbrook is supposed to be among the world’s top hikes. The last time I camped was back in January in New Zealand; it will be good to go out there and brave the elements again.

Camping gear, check; camping food, check; plane tickets, train tickets, bus tickets, ferry tickets, check, check, check, and check. Hinchinbrook is hard to get to, but good things never come easy.

I’m psyched!

In Retrospect: Yellowstone National Park

2008-05-11T19:55:00.023+10:00

Yellowstone National Park, the world’s first national park, is world-renowned for its geysers, springs, and wildlife. So, on my cross-country drive in July, 2004, I spent two nights camping at one of the campgrounds inside. Two-and-half days are definitely not enough for a national park of this size and diversity, but that was all the time I had.

Yellowstone National Park is located in the northwestern corner of Wyoming

All traffic stops and crowds gather as an elk crosses the road

Looks like something out of a Petrie dish. The thermophilic bacteria grow along suitable streams and ponds, the species and color changes depending on the temperature and pH of the water.

Over here the bacteria take on a reddish-brownish appearance

And along this stream, green and brown grow side by side

The Old Faithful – thar she blows!

Many of these creeks are replenished by run-offs from geysers and springs

Hot springs with boiling water like this one are so numerous, many are unnamed

Steam from springs blowing in the late afternoon glow gives the landscape a surreal appearance

Porcelain Basin is encrusted with calcium carbonate

The water of the springs can be clear, or it can be emerald-green, depending on the minerals dissolved in it

Grass and trees are constantly trying to reclaim the land

This spring next to a picnic area looks inviting, but it’s probably not a good idea to jump in - it's boiling

People watching yet another geyser erupt

The size of the Grand Prismatic Spring can only be appreciated from the air, this is just a sliver of it

Morning Glory Spring

The Grand Canyon of Yellowstone, although nowhere near the size of the one in Arizona, is still quite impressive

The raging torrent looks like a smooth ribbon from this height

With the spring dried up, the white calcium skeleton is what’s left of Minerva Terrace

These unfortunate trees stood in the way of the water spilling out of a spring

View from top of Minerva Terrace

A herd of bison grazing at the foot of the mountain

The road out of Yellowstone and into the big sky country of Wyoming

The road winds its way up the side of a mountain just outside of Yellowstone

Regression of the Mind

2008-05-07T22:41:00.001+10:00

At memory clinic today, one of the patients was accompanied by her daughter. The patient, in her mid-eighties, was originally from Poland but has lived in Australia for the last forty years. She was diagnosed with Alzheimer’s Disease four years ago and came in today for a follow-up visit. As her daughter described it, the progression of her Alzheimer’s Disease, and her dementia, has made her more and more dependent on her daughter. Besides the lost of her short-term memory, she has almost completely lost her ability to speak English, which she was able to speak fluently before, and now relies on her daughter to translate for her. She happily recounts in Polish stories of her, as a girl, gathering firewood from the forest to make dinner at the eave of Germany’s invasion of Poland.

Ah, the ravage of time, that great equalizer. When people live long enough, few can escape the its grasp. As dementia sets in, the awareness in the early phase evaporates, leaving its victims blissfully oblivious even as it becomes increasingly distressing to their family members. It doesn’t matter whether he might have once been the CEO of a multinational corporation or an ordinary farmer, he simply regresses back to a child-like state. The loss of the ability to make critical judgment, the ability to remember where one lives, the ability to recognize one’s family member, and the loss of skills learned later in life, such as speaking a second or third language, are all part and parcel to the disease. At the end, one becomes dependent even in simple things like feeding and toileting. And thus he leaves this world just like he entered it.

Sometimes I do imagine that if I get to live to the ripe old age when I am babbling in Cantonese, with Mandarin and English, my second and third language, respectively, just a glimmer in the deepest recesses of my atrophied brain, what kind of stories would I be telling my grandchildren or my geriatrician.