Books

University libraries smell different. They smell of old books and recycled air and ticking clocks, the same as other libraries, but there are different notes too. The smell of toner and carbon copy paper. Ink. Sneaky bottles of caffeinated beverages.

I am studying again, in a library even though I have an office at home with lovely natural light and white bookcases filled with texts. Somehow the artificial bright white light and the smell of toner and copy paper are more meaningful and I study better when I am here in my jeans and my hoodie in the middle of Summer with my feet curled up under me on the chair.

It is University holidays so it is quieter than usual and the quiet is welcoming. I like the tapping of the other computer keys and the click as the second hand navigates the clock on the wall. I like the clearing of throats from some unseen person in the corner and he librarian shuffling her things around in between checking facebook. I like the rumbling of the heavy metal cart that they use to replace books on shelves and the way it clangs across the tiles. I like the noisiness of the silence as the airconditioner hums in the background.

My newest textbook is open in front of me, its pages gilded at the edges so that when I get to a new page that I have not opened yet, I have to separate the pages. Proof that this is mine and mine alone. Somehow, for a brand new book they have managed to colour the pages into a sense of age and the type set is ever so subtly incomplete so that little chunks are missing out of letters. I love it. It looks old even though it is new.

I have always preferred new books. The excitement of birthdays and Christmas mornings when a brand new book smelling of brand new book would be opened and the first creases to be put into the paper spine would be caused by me and my reading. Even as an adult, this preference persevered, I think because of the novelty of having something new.

When I was a teenager, I came across the red cloth covered volume of Tennyson's poems from which this blog takes its title that belonged to my father. I have no idea if he bought it new, but I suspect, owing to both its age, condition and his financial status when he bought it, that it was not new. I have always loved it. Stole it from home, technically, without asking, because of that desperate love for it. It went to university with me, and lay on my cardboard box of a bedside table under the posters of wizards and dragons. I love that it is a book from history that has history of its own.

Earlier in the year, I was desperate to find a book that is not available in book stores. Even though it was an award winning book, it has not been republished in some time. I have its sequel, triumphantly scavenged from a second hand book fair but this book, one of my favourites of a childhood that refuses to end completely, has eluded me. I don't think I ever had a copy of my own - it was only ever a library book, so with the magic of the internet I searched for it.

The Book Depository didn't have it, but they suggested Abe Books, who I'd always been vaguely suspicious of. The idea of buying used books online feeling strange - I'm not sure why given my op shopped collection of Trixie Beldens. But they had my book, in a tiny independent store in Perth of all places in the world, and it would cost me merely $2. So I bought it, wondering how defaced the cover would be and if there would be pages missing.

There weren't.

Like the first time I'd read it, it was a library book, with the library plate still on the inside of the cover and the stamps from those who had borrowed it before, just like the one I'd read as a child. It was a different cover, so it wasn't *my* book, but this one, with its own history, that many other children had read before me, was somehow more special than any other. A new book would not have been the same because I'd already read it, had cracked the spine and smudged the pages. Had cried on a few. This was more my book than any reprint ever could have been.

I also bought, on the same day, for the princely sum of 2 pounds, Jane of Lantern Hill, the last written and published book of LM Montgomery's life. And it came to me with a piece bitten out of the cover and a little girl's name written on the inside cover in a childish script and although the book itself was not anywhere near my favourite, feeling like an idealised and slightly beatific version of Emily, it belongs on my shelf, because it too, was beloved by little girls who belong to the cult of PEI.

There is no other option, if I want to complete my collection of Trixie Belden's, especially if I want to know what happens in the last 2 books that I've never read. Unfortunately, due to the popularity and scarcity of these books, they are being offered at ludicrous prices of over $40 each online. There is part of me, though, that needs to know, desperately, if Jim ever kissed Trixie, after the lead up of all the books before then. But somehow I think I'm going to be disappointed. It's kind of nice, in a way, to know that the series has never finished for me, and that those books are still out there.

I wonder sometimes, when I look at our well worn copies of Harry Potter, and muse regularly about whether I think Snape was in fact part of one of the best stories ever written about unrequited love or just a slime ball if my girls will ever feel the same way about books. I hope so, because there is something still, that no e-reader can ever give, and that's the smell of type print that smears just a little under sweaty hands and tears that fall over stories that seem too real. And the way it feels to slide your fingers between gilt edged pages to open something that has never before been opened, and to learn something new.

In which I write a title which is too long because I can't think of a good one.

Papery skin that bruises if you so much as look at it is surprisingly tough when it wants to be. The mess of haemosiderin in varying stages of decay splotched over cubital fossas and the cool flaccid turgorless dorsal surfaces belying the sheer grit of vessels that stare down the tip of my guide needle and dare it to pierce the flesh. And yet, even as I push and pull and prod, probe in one hand, fingers nimbly dancing with needle, each subtle stroke as with an épée, those who have most to complain about so rarely do.

"I'm Jennifer" I say brightly, clacking into the rooms with my very high heels and my pretty dresses and the hair that refuses to behave and ruins the whole effect, "I'm one of the doctors". And so many of them, on hearing this, relax straight away. As if those letters after my name actually mean something tangible and meaningful and that the fact that I'm about to poke them with sharp things is not something to worry about.

Sometimes I sit on the end of the bed, and have a chat about what we're about to do. Sometimes I chat while I'm washing my hands. Sometimes I hold onto the papery mottled hand and smooth out the bruises and cluck while vowing to not put another purple mark on skin that is so fragile and yet so tough.

Sometimes as I explain, the fear creeps up over skin, especially in those that are younger and the thought of pain has them recoiling from me while sheer force of will keeps them stoic. Some want to see my tiny needles and are reassured. Some screw their eyes up tight and look the other way.

When I am chasing a lesion - a mass of cells that doesn't look quite right - I turn the screen towards so that they can see too. They're there and they're part of this, it's not right for me to hide it from them. "See that white line in the middle of the screen?" I gesture as I hold the probe in one hand and point awkwardly with the other. And there's a definite pride that almost everyone gets when they realise what they're looking at, as I describe the bits that are important. And while almost no one wants to watch the needle or the biopsy gun pierce their skin, often they will be riveted to the screen as the sharp white line of my needle comes into view and reaches the mass of cells that they can identify too. Solemn quiet until the sharp click of the trigger as I withdraw.

"That wasn't so bad" is one of the commonest responses I get. But the one I get most is often "Thank you". I find it awkward when I'm thanked for hurting someone, because there are always bits that are a little bit painful, but I always hope that it hasn't caused fear and that the things I've explained, and described, so that the unknown ghosts can be chased away a little have helped.

Sometimes the response I'm given is that "That looks easy" and in some ways it is. It only takes a steady hand and some coordination. A bit of training and an understanding of the anatomy so that my needle pokes into the mass of cells and not into an artery or some such other important structure. And as I switch between hands, sometimes left dominant, sometimes right dominant (I'm sure the nurses think I'm doing it just to confuse them) it feels easy now. My needles go where I want them to go and I'm quick. I'm quite proud of that, because the frustration that gathered between my eyebrows the first few times as everything felt clumsy is largely abating. Sometimes things are harder, and I bite my lip and frown at the screen and fiddle with the dials until things look better, but I no longer feel like I'll never be able to do this, because I know I can.

And when I see my neat little purple line, exiting through the tiny hole in the skin; and the antibiotics can be hooked up or the chemotherapy started and my neat clear dressing is snapped into place and I don't see any bruises, I feel ridiculously satisfied. When I've applied my clean white dressing over the single tiny hole that leads to the subacromial bursa my pride gets a satisfied pat. Or when I'm standing next to my machine after the biopsy is all done and I can point with unsterilised hands to the point where my needle went in and the picture of how close we were to the artery or the nerve or lung or aorta but how I could see where I was all the time so that I wouldn't cause any harm and that look of amazement crosses both our faces, as we realise what we've both just achieved, I know that this is all very worthwhile.

I help. I heal. I still hold hands. I still explain even if it takes too much time. But most of all I love what I do.

My hair is longer.

Wrap up posts are always a bit tedious. Both to write and to read. But we write the equivalent of the mass mail out Christmas letter because we feel the need for a punctuation mark in this little written universe of ours. So here goes...

There were and are plenty of things I could write about, but the first thing that came to my very very tired mind tonight as I bullied myself into writing the sort of post I usually glaze over, was that my hair is longer than it was this time last year. Quite a bit actually. Sometimes, in the tedium of growing my hair and trying to keep it looking healthy, it has felt as if it's not growing at all. That I'm spending all this time pursuing something that's just not possible, and as far as poorly drawn metaphors go, that about sums up good portions of this year.

But whining is not attractive at the best of times, and even at the worst of times it's not really one of my defining characteristics, because no one ever achieved much whining, and I've always been an overachiever.

So here's a few things I actually achieved this year:

I started drawing again. I've talked about it and half heartedly tried to pretend I was making an effort, when in reality I wasn't doing much of anything. But this year I really did, and I was even brave enough to give some of it away to a friend who deserved something much more impressive, but who was properly appreciative of the effort and thus I love her to bits.

I started a training program for a Royal Australian and New Zealand medical college and got excellent reviews. I got referees to say wonderful things about me and make me cry (in the good way). And if I didn't pass my exam first go, that's ok, I can do it again.

I moved into my first house all on my own and not only survived, but enjoyed myself. I went to the beach after work and sat on the sand. I stopped and bought icecream just because I could. I stayed up to late and read crappy books to cure the insomnia. I got up too early and did yoga on my purple mat.

I came home to my beautiful family and never want to leave again. Though it would be nice to still be able to pop down to the beach after work, or to the top of the mountain. I'd still rather come home to a noisy house full of squabbles and laughter and hugs and tiny sunburned hands that grip my fingers and steal my pillow in the middle of the night. I sleep better here.

But in general , 2012 was far harder than I anticipated, and in ways I hadn't expected. It hasn't been so much about enjoying as surviving and it's not my favourite way to live. 2011 finished on such a high - home from Paris, a major life long dream fulfilled, succeeding at work, succeeding at home, loving my beautiful children and with dreams this year of saving for our first home together. And I think that has what has been hardest this year, not the long hours, though they have been longer than almost any other time I have worked, or the stress of Bingley's prolonged unemployment, or the financial difficulties, or my weight gain that has been enough that my beautiful clothes that I wore to Paris pinch and no longer drape as they're supposed to. No, what has been hardest of all is that it has seemed pointless to dream, for fear of disappointment, and with no tangible goals to work for, I have floundered.

So for 2013, my goals are these - to have goals again. To work for them, even if they are smaller than the dreams of a year ago, when circumstances were different. To feel beautiful again, and dress accordingly. To learn how to curl my hair in curls that last longer than the time it took to put them in. To pass my exam. To go on a holiday, booked and planned in advance, even if it's not as glamorous as Paris, and sit in the heat with Bingley with limp hair and drink mojitos in the sunset.

Sometimes, I forget I'm 31, and I want someone to swoop in and save me. To make me feel clever and fun and beautiful and to make it all easier for me. To not worry about money or learning or holding the steel that is pressed against a person's heart and controlling their fate. To wake up and worry only about doing my hair and  making breakfast for the family and planning dinner and listening to homework. To still feel like there is magic and joy in the world.

But it's not my job or my study that takes that away, and no Disney Prince could ever give it to me either. And there are moments of magic still, when I make someone laugh, while taking away the fear of the procedure I'm doing. Of being thanked by the big burly security guard when I've given him the joint injection that means his arms work like they're supposed to. Or the little old lady who tears up when I am the first person to explain what it is that she's doing in hospital and why I'm doing what I'm doing. Who holds my hand with frail paper skin that buckles under my blade and bruises at a whisper.

Little old ladies always comment on my hair too. My beautiful long hair. I guess that's another thing I achieved: I have my old hair back.

Sun setting on 2012

PS I want to write about Christmas
PPS I want to write more this year. And not just because Liss told me to.

Eclipse

I woke with the curtain brushing across my cheek and the morning sun already filtering through my lashes. Tomorrow, the sun will wake me again, before disappearing, hiding behind the moon. Last week I would have been just under the path of the true eclipse, hoping for a fine day - though what other sort of day would I have had in the place that hadn't rained for 3 months? But I would not be anywhere else but here, enjoying the partial eclipse from the verandah as the breeze rushes up the hill.

There's an excitement and romanticism about the eclipse. One that extends to its very name despite what Stephenie Meyer may have attempted to do to besmirch it. I imagine there will be many proposals tomorrow under the dark morning sky - promises to be lights in darkness, suns to moons etc etc. The thought makes me smile, but I am still happier home with my partial eclipse and my partially romantic life.

Because, after 18 hours along the Bruce Highway I am home. Properly home. Not just for a weekend, not for a holiday, but home. I have given up my little flat with the wallaby that came in the mornings and the evenings, foraging in the grass. I have said goodbye to the little room where I danced in the dark and the friends I made in the middle of the night. I am back from being someone respected and feted to bottom of the ladder again and it's the way it should be.

I received an amazing end of term report and even nicer personal reviews. There is nothing quite like the feeling of having your mentors think well of you, and not only think well but share that with you and with others. To have people that will remember you, long after you've stopped working under them but will write nice things when a reference is required. But even nicer is the knowledge that they liked me as a person, respected and genuinely enjoyed my company. It made what could have been an awful time not only bearable but valuable.

In some ways it has been hard coming home and being responsible for hair brushing and dinner for 5 and setting the table and loads of laundry. To a husband that not only has never thought of writing me sonnets about suns and moons but who has become profoundly depressed about his lack of employment since I've been gone and as aware as I am that my hours are now much less and I am earning barely enough to keep us all afloat. To the extent that I am looking for a second job because a life of just getting by is too difficult.

But somehow, even with those stressors, I'm still happier home. Where I'm woken in the morning by the brush of curls under my chin and the sun in my eyes. Even if it will be hidden for a time tomorrow. The shadow will pass. And it's not the same unless I was on a yacht anyway, watching the moon ink the waves.

November 3

I am so out of practice with the writing thing that I thought I would try and write every day for the next month. A plan that failed spectacularly when I realised that it was already past the first of the month and that I had not written a word. I wanted to write about not me, and not my work, but because I find myself both tired and lazy, it's hard to think of much else.

I leave soon. Within a week this little 5 roomed apartment will have another tennant who may or may not care about arranging the furniture in ways that are designed to be appealing when you walk in the door. They may not bring flowers in every week or go to Bunnings and buy big leafy green plants to purify the air and soften the walls. Who won't leave out their overripe fruit for the wallabies. Who won't wash on Sundays and mop the floors on Wednesday nights. And curl up on the couch with the contrasting cushions and the soft fuzzy blanket on the nights when it's hard to be alone.

In spite of myself I have loved it here. Being alone for the first time in my life has been something that I think I needed without even knowing it. It will be hard to go home to a house of continual noise and competing needs. Here the only needs have been mine. I have been allowed to be completely selfish and it has been nice, though I'm glad as well that it's over.

I went out last night with a friend. A friendship that forged on quickly the way they used to when I was a child and I would be only in one place so briefly that it was a necessity. It has been fun. I've forgotten what it was like to just make friends without having to fit it in between everything else. And I've had opportunity for more but have held back a little. Knowing I'm leaving and not wanting to leave too much behind.

We went out to a pub dressed the way I would have dressed if I was a 30 year old woman who had nothing but a little apartment to go home to that was always cleaned on Sundays, even if it was 2 in the morning. Who spent her time doing yoga when she hadn't gone to bed too late reading terrible literature and ate asparagus dipped in fried egg on the couch when she came home from on call shifts. A sequinned dress that dipped a little over the cleavage and far too high on the thigh, pulled together with a classic black blazer so that it was just that little less obvious.

I kicked off the sparkly platforms, rejecting them for their very sparkles, put on the simple pumps instead and headed out to a venue that hadn't yet kicked off, driving myself so that I couldn't drink while my carefully curled hair went limp in the humidity. We played pool and drank iced water while the crowds ebbed and flowed. Losing the game by sinking the white on a foul shot with a rueful grin.

We found a livelier bar later and while she danced I perched up on a stool and people watched to my heart's content. Not needing to make conversation and enjoying myself quietly. Apparently an open invitation, that clearly I was in need of company that was offered often, sometimes politely sometimes not. Rejection that was taken and sometimes not. Grateful for the bouncer that moved along one man who seemed unable to understand my reticence.

It was worse at another club, where I was physically pulled onto the dance floor and another where I danced to try and make myself less conspicuous (my dancing is terrible at the best of times) and was immediately approached. Touched. Something I've never been fond of and we finally went somewhere where the crowd were less forward. It surprised me because as a tiny 18 year old I was always hyperaware, hoping for attention and it was a rarity.

But for that, I enjoyed myself. It was a punctuation mark about this whole interlude. A break from reality underscored by a strange night that smelled of acetaldehyde and cigarettes, bad fake tan and worse fake hair. It reminded me of the artificiality of this whole experience. Of how even though the nights I've been able to spend looking after only myself eating what I wanted, when I wanted, falling asleep on my preferred side of the bed instead of the one I've been designated and tangled in sheets that don't overheat and smell like clean laundry. Of the few days off spent doing whatever I wanted to do. For all that I still want, more than anything else, to go home.

I want the girls. I want to see their homework and do their hair for ballet. I want to read their funny stories and hear about what they did at school today. I want to wake up with the Possum standing by my side of the bed in the moonlight, waiting for me to lift the covers so he can curl up into me and steal half my pillow. I want my house with my porch and the smell of hot nights in my hammock. I want my new antique cedar dressing table with the mirror that's flaking on the sides in that perfect way that old mirrors have.

But most of all I want Bingley.

Epoch

This time three years ago I was sitting in a large lecture theatre with my notes in a perspex folder as I listened. In front of me, nestled in my lap was the beginnings of my belly, that would continue to swell for the next few weeks as the Possum grew. I was no longer a student, and yet sitting there in the lecture theatre, I may as well have been, and life was not so very different to a few weeks earlier when I had been just a student.

My clothes were plain and boring. Partly because maternity wear was mostly plain and boring and partly because I couldn't afford much else. But it was also because part of me didn't care, and the part that did was too vain to accept that I couldn't wear the sorts of clothes I'd like to. I liked that I got a free pass in pregnancy anyway, as I listened to those lectures, surrounded by the excited hubbub of my fellow interns as we prepared to step out into the world for the first time and use that hard won "doctor" in front of our names.

We were naive and excited and optimistic. We had survived medical school and the world was ours for the taking. Bring on the ER scenes of jumping on someone's chest and watching them come back to life while we patted ourselves on our backs for a job well done. The fact that my first arrest that I arrived at was a shambles should have given me a heads up, but that naive idealism pervaded my first few months of medicine. And every time someone called me "doctor" a thrill went through me, as it registered that yes, I was.

I went on maternity leave, came back, and I chronicled the disaster that that was. I didn't come back with my adrenaline fuelled idealism and excited determination to make a difference. I came back desperate and isolated, dreading being at work and dreading being at home. It is no wonder that those first few months were so horrible that I have nearly blocked them from my conscience. But I survived them. Barely. And ended up in Palliative Care.

Palliative Care was to be the hardest and possibly the best rotation I did as an intern. I fought against it, it was the area of medicine I feared most, my personal experience being limited to ideas of giving up and saying goodbye. I learned it was not like that, and that the people who go into this area of medicine are the most dedicated and caring doctors I ever met. There is no money in palliation. Very little respect. So those that are there do it because they truly want to make a difference... and they do.

But by the end of 3 months of dealing with those that were sick and dying and afraid, I was a complete mess. Breaking point on so many fronts, falling apart while being the best doctor I could, leaving behind a family in tatters and so fragile that I felt as if I were made of glass. Transparent and brittle. But there was one saving grace, one tiny spark inside that illuminated through my limbs. I was a better doctor.

For the next 18 months I worked so hard that sometimes I'm not sure I slept. I learned to laugh again. I left home in darkness and often came home in darkness. I learned so much. I learned what it feels like to do chest compressions on someone when rigor has already started to set in. I learned what it's like to push a catheter into an epidural space and the unique joy that is seeing crystalline fluid drip from the end of the needle to show you're in the right spot. I also learned the fear in seeing that fluid flow bright yellow, thick as mustard.

I ordered x-rays, I attended crash calls, I took more blood than flows around my body. I prescribed medications I'd never even heard of, and looked up the formulations on MIMS guiltily, wondering how it is that people have so much faith in doctors. I became so slick with taking blood and putting in cannulas that other doctors would call me to come help. I made people laugh at 2am in the darkness as I punctured their feet and finally found a vein in the circle of light from the lamp so that they would mind less at the tourniquet and stop being so terrified.

I sat in the doctor's lounge and watched the sunrise more times than I can remember. A full lunar eclipse one night. Fireworks another. I fell asleep on the chairs, with my pager clutched in my hand, waking instantly as it vibrated and dashing off to put out more fires. I learned to do so many things that it didn't matter if I was mostly asleep, so long as I could do them effectively and not cause pain or fear.

I experienced death. I learned the smell that heralds multiorgan failure and felt the keening pain of it when it happened to someone I'd come to know. I found that there's comfort in sitting next to a bed in the twilight, when no one even really knows you're there and listening to the breath of someone whose inhalation may be their last. Tinkering with the syringe driver to make sure that everything was perfect. An event coordinator for the last moments on Earth. I learned there are good deaths and there are bad deaths, and tried to explain the difference to the desperate and afraid. I cried sometimes, but not very often. The worst days leaving me empty so that I didn't even know how to feel.

But I experienced life too. I saw patients with head injuries so bad that every morning I'd hold my breath a little, waiting to see if this was the day they'd deteriorate. I saw senseless injuries in people far too young to know what the inside of a hospital looks like and permanent disabilities while families smiled tight smiles and became excited by the opening of eyes. I saw two young people, both barely out of their teens, both have injuries that should have caused death. And they languished on the ward for weeks, barely changing, barely alive. Hearts and lungs that still work as 20 year old hearts and lungs should, but everything else at the mercy of a petulant brain.

And I watched one of those 20 year olds wave to me on the last day. Watched him start to show signs that his brain was waking up, and though he would never again be what he was, that he would be something more than what he had been, when I had washed and debrided the wound on his arm that he could not feel as it laid limply by his side. I saw one of them walk into the ward, a few weeks after she'd been discharged. Not ever again who she was, but smiling and walking alone. A girl who had lain silently in bed for weeks, only one side of her body responding to painful stimuli who had progressed just like the miracle pundits tell us.

But I saw many more who didn't.

I've done psychiatry and seen people trapped in their own minds. I've done pain and seen the same thing; those looking for a magic wand that doesn't exist - a silver bullet that will suddenly make them "normal". Seen some that engaged and accepted, went on and understood how to move past the pain and live the only life they have. Saw plenty more who couldn't. I did general surgery, abdominal surgery, orthopaedic surgery. Stood in theatre in the middle of the night while swooning a little from tiredness as I held a retractor. Gloved up and gowned, felt the sweat roll behind my visor and yawned again behind the mask.

I did months of neurosurgery and fought an inner battle with myself. One version of me somewhere is a surgeon, and operating on brains and spines, giving hope to the Harveys of the world. But as I watched the dedication and the enthusiasm of the registrars and consultants that I admired so much, I knew that I just couldn't. I wanted to so much, but the toll it was taking on the girls and Bingley was too much. I knew if I pursued it that I would lose my family. In short months I also lost nearly ten kilograms, and while I've maintained most of that, and I can't pretend that I don't like it, it played havoc with my health.

And now I find myself here on the very last day of being a resident doctor and I feel overwhelmingly sad. In the last few weeks I've felt relief that it's coming to an end, but the wards and their smell seem welcoming somehow. I know this rabbit warren of a hospital better than most. I know the secret passages and the stairs to everywhere. I've practiced on just about every ward there is in every building. I know the nurses and the fellow doctors. I know the ones who've been here forever and the ones that are only just making a name for themselves. I've made friends who will stick up for me, cover for me and tell me roundly when I'm being a twit. I've found referees that say glowing things that make my neck feel hot and my eyes prickle suspiciously.

And I sit here on my unpaid lunch break, in my tailored sleek dress with the shiny accessories and amazing shoes that I would have only dreamed of three years ago. My pager in front of me, my smart phone on my notes and I wonder at how hard it is to push forward. To accept change.

Part of me wants to just stay here, to keep doing this, at getting better and better at it, to not go down any more tunnels but to sit out here in the warm wind and the light. It has been an amazing three years. A terrible three years. I am so much older that I was three years ago. And if I stay here it's warm and it's comfortable and there's no risk at all.

But deep in my belly where the Gleam resides, there's a warm and flickering fire and that curl of anticipation that a little girl felt as she lay her forehead against the window as she sped to another destination, another new beginning. I don't exactly know where I'm going, I've just bought a ticket for the train and once I'm on it we'll speed away. And sometimes we'll travel through tunnels, and there will be no light anywhere at all. But even in the darkness we'll keep on moving forward, until I'm in the light and wind again.

Gone fission

It is a beautiful Summer afternoon and the sky is such a uniform unearthly shade of blue that it does not look real. There is a beautiful breeze rustling the trees and my Michael Kors ensconced feet are up on the verandah railing as I sit back and watch the world go by.

Work is very very quiet this week, to the extent that I have no patients at all, so my time is mostly spent trying to wrap my head around the mind fuckery that is quantum physics. It requires such logic and straight mathematical principles, and then requires you to suspend that logic and use abstract imagery which is then re-incorporated into those structured mathematical principles. Once upon a time I thrived on it, the idea of logical magic. Ordered chaos. Fractal dreams. But now that I am studying it in earnest, my brain often hurts.

Today after successfully expanding the edges of my brain with positron annihilation (one of the coolest named concepts in science) I tried to integrate the exponential coefficient to determine the scatter or something or other and the particular neurons that were lying in post-orgasmic annihilation bliss rolled over and started snoring. So I did the only sensible thing really and drove to little Italy and ordered an apple gelato. And a piece of pistachio cheesecake. And sat in the window of a little slice of Italy while the cricket was broadcast under the Eiffel Tower and savoured every last bite.

One of the things I miss most about Paris, and Bangkok for that matter (still haven't written that post yet) is the ability to find somewhere to sit and eat and reflect on every single street. There is so much scope for wandering and so little for cars or other mindless transport. There is such social pleasure in isolating oneself at a teensy table that rocks precariously and to sit there all alone and watch the world go by from behind the shelter of an enormous pair of tortoise shell sunglasses.

I love that meal times are so sacred in Europe that it's expected that a good proportion of students will go home from school to eat with their family, all around the table. Though half of my family are screaming at present after the game of bouncing each other on the hammock (which was prohibited less than 2 minutes before) resulted in the inevitable de-hammocking face first while the other one is coming to grips with "uneez" in the tiniest underpants ever invented.

It's not quite dark enough yet for the birds to be singing, the trees are still drenched with sun even as the moon presides brightly in blue. Bingley and I are busy being entertained and awed by the Possum doing a 24 piece interlocking puzzle without assistance. He is quite proud of himself also.

The scrub turkeys are making a nest in our front garden and they are becoming as tame as the possums that take food from our hands. They make such a mess and are such ugly birds, but I love living things being around me so much that I don't care.

The solar detector for my tree lights is full in the last rays of sunlight so that the second dusk falls there will be twinkling stars just out of reach to wish on even if the clouds come cover the ones in the sky. And with my physics book on my lap I can even explain to you why the stars glow as brightly as they do, right down to the little quarks at their centre. And even if it hurts my head, I'm glad that I'm learning this. Answers to questions I never thought to ask. Fizzpops of knowledge snapping away through my neurons like sherbert. Fusion on a tiny scale.

**Edited to note that I finally posted Part One of Bangkok**

Hope is the thing with feathers

That perches in the soul,

And sings the tune–without the words,

And never stops-at all,

— Emily Dickinson

It is a truth universally acknowledged that things that are most hoped for only happen when you have truly given up all hope of them happening at all. As a hamster in the wheel of a large hospital, it was beginning to seem impossible that there would ever be anything else but feet blurring in front of me as the wheel spun around and around, the same faces, the same diseases and becoming mired with the feeling of helpless impotence. After my disastrous and ego quashing interview earlier this year, and the subsequent rejection for a higher position, I moped for a little while, before becoming philosophical and choosing a new path with fervor. One that encouraged me to read more books in the last month than in the last two years combined. 

I had sketchy plans of applying again, though the tiny sting of rejection still burned a little - a not quite healed paper cut over which fresh lemon was squeezed with memory. Until today when a phone call restored my dreams and ambition and told me with cheer that there was another light, along another tunnel and that I would one day not be just another junior doctor, at the whim and mercy of hospital bureaucracy and ancient consultants. 


I have been accepted into a training program, and now start the final descent into formal study (or hell, depending on your perspective), from which I will emerge as a fellow of a Royal Australian College. And at the end of these five long years, I will be able to work hours that will allow me to take my 12 year old to her school disco, and keep a watchful eye over her. I will be able to cuddle my 9 year old in bed every night, EVERY night, and read her stories if she will still let me. I will be able to be "that" parent that actually helps in a classroom and is there to help her 6 year old son read his first readers. 


It sometimes feels like I have done too much already, more study, more hard yards than most people do in their jobs. I am simultaneously anxious and terrified about this new position - about the new responsibilities and the study and cost that will come with it. 


But even when I think with rising panic of all that is to come - I see what lies beyond it, shimmering beautifully. And I think of all the wonderful times I had while studying, even when panicked and anxious - the total joy in learning and studying, I have so much hope for the coming months and years. 


I will be a nervous wreck. I will second guess my decision and my abilities and all that is within me. But while the beautiful song of hope trills through my chest, I know that I am working for something beautiful. Something worth having. 

Not Paris.

When I arrived she was leaning over the bed, face blue as she gasped for breath. My entrance shepherded by the others called by the emergency page for a young woman who couldn't breathe. The mask went on, the lines went in, like a well greased machine and the clothes were ripped from her chest so that we could stick on the leads for the defibrillator. I was there when she stopped breathing, and it was my hands on her chest as the ECG showed a flat line. Her ribs far springier than any others I'd ever felt, because she was at least 40 years younger than anyone else whose chest I had compressed, the beat of Staying Alive dancing irreverently through my head as I counted 30 - two pumps on the mask. Adrenaline, atropine, bicarbonate, magnesium. My fingers on the cricoid as the ETT went click click click beneath them.

Mobile radiographer arrives, chest compressions continue. There's a rhythm - now it's gone. Tiny pulse, now no output. That smell. That death smell. Pumping on the chest, arms tired, swap with someone else. Keep pumping, 20 minutes, 30 minutes, 40 minutes. Infusion. ABG. Acidotic. Pupils fixed. Compressions cease. 38 years old. Curtains now closed and everything left, just a blanket drawn up. Phone calls in the middle of the night. 

Feel pointless. Wonder if she will get bruises from the futile weight of my arms and hands on her chest. Detach. Sit on the ward and read through her chart, search for an answer for why it all went wrong. Listen to the call to the coroner. Lean back for a bit. Feel morose, feel reminded of all the people who wonder why I do this job and if I agree with them. Shake myself, answer more calls, forget her name and feel guilty about it. It's on a sticker somewhere. 

Working weekends

It is cold this evening. I am under the doona and have my new favourite charcoal hoodie keeping my ears warm. The windows are open of course, because I hate closed rooms, and I love the smell of the cold wet air. I woke in mist. Pale grey and damp, swirling quietly. It was a morning for sleeping, cosy and comforted. But I went out into it, drove into the sunrise as it evaporated away the clouds.

I love being out early in the morning, even when I'd rather be in bed. The other people who are awake with me always seem the happiest. The fittest. Running and walking and glorying in experiencing as much daylight as possible. Often I'm still feeling slight pangs of regret about not still being in bed, but driving into the sunrise perks me up every single morning. I love seeing the beginning of a day, and not wasting any of it.

I have perfect eyebrows tonight. I had them waxed and tweezed this afternoon by a girl at a cheap walk in place at our local megamall. I am wary of these places, as I have had some odd experiences with sperm brows or accidentally removing far too much hair. But these current brows are perfect. And cost me $15. They are a bargain, and if only I was not curled up under the doona in my pyjamas, I could take them out on the town and show them off.

I was at work today, and it was mostly dull. I have had enough of rude patients on weekends. I dislike it immensely. I recognise that pain and fear and suddenly being weaned from cigarettes and alcohol and having to depend on others is traumatic. I understand that some people cope better than others and I understand that sometimes you catch people at bad times. But truly, clicking your fingers at me, asking for a "real doctor", shouting obscenities at me or being rude and abrasive when I ask you politely if you have any specific worries on a Saturday when most people are at home with their kids is not fun for either of us. Ignoring me will not make either one of our lives easier either.

The life of a junior doctor is not glamorous. Scrubs is true. All of it. I grimaced to myself the other day as I stood by the lift balancing coffees (I don't drink coffee) for the morning meeting. 10 years of university education and I'm fetching coffee. I have had consultants that don't know my name, who have ignored direct questions and speak directly over my head, issuing orders for me to my registrar when I'm standing right in front of them.

I have stood in semi darkness with a single bulb over me, sweating profusely as I try and poke a cannula into a vein from someone that has been "handed back" from IV services. IV services put cannulas in all day. That is their job. I'm lucky if I do one a week at present. You do the math. And often aside from the cranky and already jabbed patient looking at you witheringly you will have a nurse, and maybe if you're lucky a student, huddled in your bay as you flush deep red, sweat running in rivulets down your back as you attempt. If you succeed, the accolades and the sheer achievement will put you on a high for hours. Right up until the point that you are paged to the ward, as the patient has pulled it out.

I dream about veins. After one particularly brutal run of ward call, I started noticing the veins of every person I met. I would be carrying on a conversation with people, while thinking about which vein I'd cannulate. The juicy one right there? Or the smaller straighter one? I stood on a train once, and as we all gripped the overhead bar as the train lurched out of the station I had already triaged the people around me based on their vasculature. Subtly when someone shakes my hand, I will be feeling for the plumbing under my hand, and it takes all my concentration sometimes not to rub my thumb across to check the calibre. I could get a grey in that one. 

I have been chastised by patients for having "no idea" how to treat diabetes as we look at their massively swinging BSLs. I have been harrassed by nurses who are concerned by the HI reading on the glucorometer 1 hour after a massive dose of novorapid. And I've wandered down to the ward and looked at the box of chocolates next to the bed, the cup of tea with 4 sugars and the empty Hungry Jacks bag in the bin and wondered what miracle I'm supposed to work.

I notice who all the people are who drink too much now. In the shops, at the theatre, when out to dinner. I can pick them on sight now. Not the alcos you're thinking of, the ones lying in the park with a silver cask. No, the people who work with you. The people who work with your friends. The people who work with me. Your body gives away so many signs if someone is willing to read them.

I feel the barrier start to come up slowly now. The one that means that I am no longer as affected as I was in my first year of medicine. In my first year there was so much humanity on display. I struggled to look at people objectively, I struggled often with what it was necessary to do to people. I shuddered at the cynicism of many of my superiors, while also quaking at their vast knowledge. I was the slime on the bottom rung of the ladder of the medical career, and the deference and the rungs poking up above me were well and truly out of reach. I felt overwhelmed often, but I felt cheated too. Medicine is not some mystical science. It's mostly simple patterns and a lot of paperwork. There are no magic wands, there are no crystal balls. It's just synthesising information and making sure that you don't miss pieces when trying to solve the puzzle.

I can still remember certifying my first dead body. I was terrified. Not by death, not by the peculiar rigidity or the scent of death. The man in front of me was quite clearly not alive, but I didn't know how I was supposed to prove it. It was like some of the Maths problems that I'd been given in my extension class where I had to come up with an answer and the proof of it. Often I arrived at the answer in seconds, but actually explaining how I got there was difficult.

I stood there fondling my stethoscope, remembering the signs of life I was supposed to check for and fumbling my way through it while the family stood back reverently. It's a very easy thing, to certify someone as not living, and yet to that family it had some significance. And it was for them that I stumbled through some sort of cliched message of sympathy and confirmed the obvious. Then left as fast as I could.

I've had to look at so many anuses (anii?) that they no longer hold any sort of grossness for me. The PR (per rectum) exam is still one of the most feared practices that medical students are supposed to become proficient at, but so rarely do. As a student, finding willing patients to allow you to practice your technique with someone competent overseeing the process is rarer than rocking horse pooh. And the ironic thing is, that the people that refuse to let the medical student have a go, will next week be having to deal with a junior doctor who may never have performed it under supervision having a go in the middle of the night. There is no dignity in hospitals. For all the hands I've held and all the apologies I've made, when it comes to it, your privacy will be as stripped as surely as your chest will be to stick on the ECG leads. Though luckily if you have me, I'll remember to close the curtains first.

I'm feeling tired at present, but satisfied as well. I'm getting home most days now when it's light and I'm getting enough sleep. I'm hungry again too, which is good for my health, but oddly disappointing from a shrinking point of view. I am less snappish, and I'm feeling warmer, after months of radiating cool. But I still get grumpy working on weekends, and I'm not sure if that will ever change. Especially on a snugly one like this one.