Phileosophie

I love Hollywood and American pop culture and New York because for all their demons they give you an easy reason to live each day and to reach for something grander. They sell hopes and dreams, packaged so convincingly that you buy it over and over again. Almost everytime I feel down, something from Hollywood brings me back and lifts my soul higher. False hopes, maybe, but sometimes it is all you need. Superficial things.

It is so difficult to 'compete' with extraverted people in a world that is so biased towards extraversion. I suppose I could come up with all these theories about how this problem is due to the fact that those evil extraverted folk would obviously be more inclined to force their extraverted ways upon the rest of us and make us feel inferior if we are not like them. I've been having a difficult time this term because my co-intern M is a very outspoken American girl who will fight a battle to its bloody end (even when she is in the wrong) and because I really haven't got the energy, nor desire to do so, I generally throw the towel in and let her win. But it becomes a more practical problem for me when we start to get compared by our registrars because then it starts to impact on my end of term evaluation and the thing is, I'm not saying either of us is better (I truly dont believe that is the case though M probably does) but I think no matter how much work I do, the n

There are still days when I am grumpy. In fact, it isn't that rare. But there are also more of those days when I am able to remain calm and gracious despite being loaded with more than I can handle. In a way, I guess it is a function of being more comfortable with my role as a doctor, but I hope it is also a sign of growth. Of learning patience and learning when things don't matter. I pray that I will be slow (and then slower!) to anger. I pray that it will be easier to forgive. I pray that there will come a day when I just wouldn't take things personally, and a day when I find myself slowing down , always, to make each moment, with each person count. Being a doctor has given me countless opportunities to learn to relate to other people. To attempt to find something interesting in a person I have no interest in.

I just wanted to say.... THAT I AM MOVING BACK TO SYDNEY! Really happy and excited. I will be based somewhere on the Central Coast, which is about 2 hours from Sydney CBD itself, but it will be great to be closer to my friends and to all that awesome Chinese food again. There are things I will definitely miss about Tasmania, all the awesome friendships I have made in such a quick time. My time in Tasmania has been bitter-sweet, and unfortunately the bitter has made it a little harder to savour the sweet but I am sure that when I am back in good old Sydney I will slowly, in retrospect, come to understand better all the good things I have gained from being here. Next year is going to be interesting - with one half on one side of Asutralia and the other half.. well, I will tell you about that soon. I am also very interested in the possibility of heading to Africa Mercy (part of the Mercy Ships organisation) either in 2014 or 2015 and am looking to see where God leads.

Over the past week I have been on a soul searching journey that has brought me back to the interiors of Borneo (where amazingly there is Wifi). It has been a hectic couple of years and for the most part I have been left feeling lost and uncertain about where I was in life and literally, because despite having a great job in medicine I pretty much have to go where the job takes me. I felt this struggle between fighting for my job, for a good position, in a good program, and keeping what I felt were altruistic intentions about medicine. I struggled with that feeling that life had been quite unfair given how disadvantaged I have been as a result of factors beyond my control (ie. the country of my birth). I felt the pressures of having to do well lest I fail to secure a job n the coming year and risk being sent back to the developing world that I have worked so hard to leave. I gave up a lot of time to do research, half the time convincing myself that I really enjoyed it, and that I was

I found this article interesting!  From: http://www.novitatherapeutics.com/blog/werner-forssmann-urologist-nobel-prize-cardiology  I've copied it here in case it gets deleted on the other site one day.  Over the last several years I have become interested in learning where important ideas come from. This interest includes both relatively new ideas, such as ablating sympathetic nerves around the kidney in patients with high blood pressure using a catheter placed in the renal artery, and older ones such as the idea for catheterization itself. Last week I learned about Werner Forssman, who performed the first catheterization of the heart. I would like to share an excerpt from Dr. Forssman’s biography at Angioplasty.org: "In 1929 in a small hospital in Eberswald Germany Werner Forssmann, a young surgical resident, anesthetized his own elbow, inserted a catheter in his antecubital vein and, catheter dangling from his arm, proceeded to a basement x-ray room where he docum

I've just started as the cardiology intern at my hospital and I love it. This week we do not have a registrar due to a lack of staff but it has given me the opportunity to step up and take on some tasks that I won't otherwise have had to do. Some times I feel really stretched and sometimes I get frustrated because I cannot remember what the advanced trainee wants me to do (because a lot of it isn't intuitive yet). But an hour or two out of thr work place and I look back thinking that in those hard moments I've grown. I've inched forward in my understanding of this field that I love so much. I've become a marginally better doctor. And looking back, I love every moment of it. The painful ones, the awkward ones, the extra questions, the nurses that won't leave you alone. Because through all of that I've learnt more, I've grown and I've stepped closer to my future in cardiology.

I was reading an article in Forbes today on the world's most influential women and was somewhat struck by the realisation that I float in some of these circles, loosely but in general only by one degree of separation. I have never understood why I have been allowed to meet these people and to get to know them on a personal level. I don't know if anything is meant to come of it, or if perhaps there are just so many of them that all of us know someone or other. But sometimes I can't help but wonder, what the hell. How is it that little old me knows some of the most powerful and some of the richest in the world? I am a nobody. I feel like a nobody. And yet somehow, I've made it to the edges of all this. What??

My friend was just telling me that every night he writes a short 1 page story for a friend of his and the friend writes a short page back. I thought it was an interesting concept that at least will take me away from work a little so I might try it too (and post them here!). I think initially they will just be drips and draps but hopefully in time my writing might as a whole improve and maybe the short stories might become more interesting! Let's see how this goes.

It's been about 3 years since the internship situation started. My life is settling back into a cheerful rhythm and I've recently worked some things out that have been dragging on for a while. I guess at this point what I really want to say is: God, Thank you for staying around when I was bitter Thank you for being there when I was feeling sorry for myself Thank you for not making me feel sorry when I challenged you to perform miracles Thank you for allowing me to grow, even if just a little Please give me eyes to see things fresh and new Give me a heart that is filled with peace Give me the wisdom to work through the tangles Guide my attention to what really matters Help me to see others as you see them Help me reflect something of your love for humanity Give me perserverance to walk the path I have before me Let me find rest and joy in your presence. And now, here's a little clip by Victor King and Andrew Garcia . Good men.  

I would so much rather be working the day shift this week. Three of my favourite medical students are on the ward during the day. Instead, I am stuck doing nights with someone who has been making it a point to make my life a little nastier whenever he sees me. I'm not talking about my own reg, just someone I have the misfortune of having to refer patients to. We did a term together some time back. It was all going swimmingly. In fact, I'd noticed that he was texting me at odd times, like when I was on holiday to ask if I was having fun or to say hello and stuff. He was always also inviting me out for dinner which I didn't put too much thought into because he has a long term girlfriend back in his country of origin. But on the last day of my term, something really strange happened. He started yelling at me and threatening me, saying that I had pointed at his face and thereby (going by his culture) had cursed his parents. Another registrar was in the room, an Aussie bloke

This is a short clip I shot of Mahon Pool which is behind my house in Sydney. I love coming here because it is such a wonderful place (imagine it with a little breeze and the smell of salt water).. it wasn't actually as overcast as the video makes it seem, and the thundering you might hear is actually the sea roaring as it surges to the shore. God has been good to me. I am ever thankful for the opportunity to live my life in Sydney.

"No discipline seems pleasant at the time, but painful. Later on, however, it produces a harvest of righteousness and peace for those who have been trained by it." -Hebrews 12:11

It has been a good year. I have had some time to think about where my life is heading and where I want it to go. Today someone sent me this question:  " If you could do absolutely anything you wanted, regardless of money, stability, or anything else.. what would it be? " After giving it some thought, I'd say I want to volunteer. I want to help those who do not have access to help. I want to offer hope to the disadvantaged. I want to make the world a better place. I want to contribute to cardiology. I want to help it advance as a field. I want to meet people from all walks of life. I want to learn from them. I want to hear about their lives. I want to find purpose in mine. I want to make a difference. Of late, I've had Cambodia on my heart. I have never been there, but I've been hearing a lot about it from friends who have. I want to go there and see this place for myself. And to give something to this community. I want to love them, and gain some perspective.

Today was one of those days when it just feels amazing to be a doctor. I had my first peritonitic abdomen and immediately requested consultant assistance and a surgical review. The patient was seen by the surg reg within 10 minutes of arriving at the hospital! Those of you who have spent time in an ED waiting room will know that's pretty awesome. All my patients thanked me today - all told me I'd helped them and my bosses seemed happy too. It feels great when your medical training seems to finally be producing good results. Left work feeling quite elated. (Also did my first speculum exam as a doctor today!!! Heaps fun. Last time I did it was on a practice patient who did not require an exam so it was awesome to do it for realsies this time.)

This trial was ongoing when I was a student at Mount Sinai Heart. Interesting results showing that CABG has superior results to PCI for diabetic patients with multivessel coronary artery disease.

I've been trying to pick up all the patients who've come into our ED with atrial fibrillation because I am trying to get a better grasp of this condition. Found this interview by my favourite cardiologist that addresses the topic of how to deal with this condition.

Interview with Dr Valentin Fuster at the Basic Cardiovascular Sciences 2012 Scientific Sessions .

I periodically look for interviews with Dr Fuster on YouTube because he really inspires me. The 4Ts he talks about here is what he tells all his fellows at Mount Sinai Heart. Jose was telling me all about this during my time in New York. I hope that by the time I am a cardiology trainee Dr Fuster will still be working so hopefully I will get to work with him again! I think this man is just wonderful because if there is anybody in the world who embodies cardiology, it's him, and I love cardiology. I want to know everything about cardiology. So I look at Fuster and am in awe coz one day I want to be like him. As good as him. And even perhaps, better! 1) Time to reflect - to always think about where you are heading 2) Talent to discover - to do what you have talent in 3) Transmit positivity - don't waste time on negativity 4) Tutoring - to find a good mentor

I went over all the notes I have written here since I moved to Tasmania. I don't know if I seem very downcast about it all still but I am not any longer. I have been enjoying myself particularly in the past month or two, meeting many lovely people, who as a whole have been sooo much more interesting and friendly and open than people are in Sydney. I always had my small group of friends in Sydney (who I love dearly), though they are much busier than my new friends here and much less inclined to just live life because everyone is racing up some ladder or another. So there have been some good times. In particular, I will say this for posterity - the men are fabulous. They were gorgeous, and incredibly charming, a significant proportion are ripped and they can all be very irresistable when they decide to turn on the charm. I am always mind blown by the fact that we can find attractive men anywhere. haha have definitely been enjoying that aspect of life here.

A few weeks ago my perfectionistic tendencies got the better of me. I had been teaching medical students for a few weeks and had recently changed over to my second batch of medkids when I had the misfortune of giving what I felt was a Really Horrible Tutorial. A few factors had come into play that week - the lack of familiarity with the new students, the class size which had doubled due to the first series being well-received, me feeling somewhat blase and uninspired and then perhaps also, the fact that I hadn't prepared at all for the session and thus wasn't in the right frame of mind to give the tutorial. Now don't get me wrong, I had the material for the session - it was the same topic I had taught countless times, I just hadn't gone through it as I normally do and generally felt quite unenthused about the session - I guess after doing it so many times it becomes a little boring. But the coincidence of all those factors meant that from the moment I stepped into the c

I've finally completed my first term in Launceston and have since moved on to the brighter lights of the ED. I have been much happier there, in part because of the greater autonomy and the fact that we can work alone, and in part because the work load is more sporadic and the lights are literally, brighter. The students are also  back on the wards and I really do enjoy their company. There are a few students in particular who I like seeing around. Two of them have the tendency to make me laugh a lot which is really nice. I've also been spending a lot of time at a nearby gym which has been good for the spirits. Am slowly getting back into research, after a lull due to my time on a particularly harrowing ward. Hopefully life will fall into place now. Looking forward to settling more into life here and meeting more Christian friends in particular. Not the super preachy types.. I guess just people who're a bit more like me because while I've always liked variety and love ha

I like the thought of a good old fashioned romance with love letters. aha

I have to say that today I am feeling very grumpy and unappreciated. I can't really vent anywhere else because I am reluctant to whinge on facebook (for doing so forces an entire, probably unsympathetic population to listen to you talk about how horrible your life is), and I can't really fully complain to people here given how small the population is and how word spreads. So I am airing my grievances here - hiding behind this veil of relative anonymity that the internet provides. I am being very grumpy indeed. I want to go away for a long time. I want to stop doing anything at all. I want to just vegetate for a year or so. I wish I had the freedom to do so. but there are so many obligations. Bills to pay. Careers to build. Reputations to sustain. I find it ironic that even coming to a small town like this has not changed that fact. Perhaps these things have more to do with the person, than the place. Which means I will forever be grumpy, and under the pump. Which is not a very

Here's my little Easter story - I felt sorry for the homeless (drunk?) man. Wanted to buy him a meal but a pastor there said "no. God will take care of him. Don't need to save the world. one day We'll have to answer for that not you. Now do you want to go back in (to the service).." In a tone that suggested that I could do it his way, or the highway. #whateastermessage #breakmyheartforwhatbreaksyour s? #repaycompassionwithsarcasm&sc orn

It's been 2 months and 10 days since I first moved to Tasmania for work. I am still in a quandary about being here. The longest I have had doubts about anywhere. I can't sleep, I have nightmares regularly about being betrayed by people I trust, I lie in bed for hours in the morning so I don't have to get up and face the day. And yet, it hasn't been all bad. Perhaps it is just that part of me that needs to deal with being here, but I've had some good times. Experiences that I wonder why I do not enjoy more. I've made a good friend in Carli, and we've had the kind of hang outs that I've wanted to have for a very long time. We get to watch movies with cheezles and tea. We get to go on hikes and watch swans and possums in their natural habitat and people on jet skis on the river bend. Work is okay - they haven't quite worked me to the bone, and they've probably been nicer to me that staff at NSW hospitals would have been. I'm getting to spend tim

It's hard not knowing who you can trust. It's hard not having someone who'll be there for you. Who you can be yourself with, without fear of judgement or repercusion. Who will look out for you, as you would them. Who will laugh with you, and sit with you when you cry. It's hard not having all of those things. Especially not in a small town like this one. I should get out of here soon.

Henry Frederick Harlow was an American psychologist who taught us about baby monkeys in a cage - the babies who were allowed to be raised by their protective mothers grew up with a normal temperament, while those who were reared in isolation chambers emerged severely disturbed, reclusive, with definite social deficits. These studies led to the understanding that mothers provide much more than food to an infant. She provides a unique bond that positively influences the child's development and mental health. She provides love.

I haven't spoken with Dr Fuster for ages and I really do miss him. I think I will get in touch soon.

Had a sense of disappointment today. Disappointment at how life has turned out. I don't really know how to explain it because from the outside there's nothing to really justify how I feel. Anyway, I hope the weekend will be okay... good even. May your peace rest upon me May your hand be with me May your strength go before me May your wisdom guide me.

I heard that some of the other local interns were bitching about 'Sydney interns' today. I had no words to respond because I know without a doubt that I have done nothing wrong in this particular instance. I simply love medicine, I love research, I love cardiology to no end. But there is tall poppy syndrome here in Australia, and we've entered (intruded almost) on a very tightly knitted group of interns. People do not like it when others come out 'on top'... not that I feel particularly victorious since I was never in competition with them - I was simply living my life, doing my thing. I can't help being in love with medicine. "I am sending you out like sheep among wolves. Therefore be as shrewd as snakes and as innocent as doves." Matthew 10:16

I had a thought today about a possible research/public health project that could be pursued in some form here in Launceston. I was recalling the days in New York where I noticed that a certain patient group was so different from that normally seen in a clinic. This was not just because they were incredibly wealthy, but notably, because their doctor provided such excellent preventative care that they were so much healthier than other patient groups. I wondered if we could create some sort of a 'model city' here in terms of preventative care which perhaps could be duplicated elsewhere if it works here. after all, this is a small city (seems much more like a town) with the hospital being the largest employer in the vicinity. There are not too many GPs, so we would probably be able to coordinate/standardise care or interventions through these GPs and then at the end of the project we could have a look at pre-determined parameters to see if the inhabitants of this city are healthier

It has been a smooth transition for me, from being a student to working as a doctor. There is not too much work to be done on the Stroke Unit, unlike the other units which have the interns flying around and coming in over an hour before they need to and clocking way more hours than they are paid to do. I think it is testament to how well the multidisciplinary team works in this setting. The Stroke NUM, physios, speech pathologist, occupational therapists and dieticians spend most, and sometimes all of their time working on our patients. We have a pharmacist, who covers all of this ward (so not just the stroke patients) and then there are the doctors. The allied health people, coordinated mainly by the dedicated Stroke NUM communicate every morning about our limited number of patients. By the time the doctors are in from our morning handovers the NUM is able to update us and let us know about any pressing issues. Then there are admissions, and tests to be ordered, but when everything

As I pour over the endless volumes of patient notes, in search for that elusive patient who might meet the criteria for a retrospective study that I am hoping to carry out, it occurs to me that I really enjoy being a part of this tradition. The stacks of paper go back years, sometimes decades, and some are yellowing, and in the most dated formats ever, hand-written, or typed out on a typewriter! But the way we have investigated patients remains the same. The Presenting Complaint, a Past Medical History, a Family History and Social History, a list of medications and their allergies. It seems like it has always been that way, passed on from one generation of doctors to the next.

I'm back to my old ways - harvesting data and working on my research projects till the wee hours of the morning. These are the moments when I feel most like myself. Me, youtube and a mountain of data to sort through. I think research and conferences are the highlights of one's medical career. They're the 'big events' that I look forward to, instead of all the balls and gala dinners that others may enjoy. It's been good getting into a bit of research. It helps me miss Sydney less and keeps my eyes on the prize. This is the condition in which I feel most comforted. Oh, and I'm heading back to Sydney next weekend! So looking forward to that.

A number of things have occured in the past year, that have reminded me to keep the right perspective on life. When I was in New York I remember telling Dr Fuster, that I wanted to be like him. I wanted a career like his, I wanted the impact he had. Those are all good things, but it's important to keep the right perspective. Today I spoke with one of the older doctors. He looks like he might be in his 50s and he says he was a fully qualified surgeon back in his home country in the Middle East. However being in Australia has meant that he has been unable to work as a surgeon, and instead, has been working as a surgical registrar for over 10 years. When he finally decided to apply for registration, he was offered a contract by one of the hospitals here, only to have certain promises broken when he finally arrived. "When I got here, I was enthuasiastic. I did research. I loved surgery. But they have broken me." He said. I offered him some words of consolation, but nothi

This is usually what you see when you look out of the windows in Launceston. This is my 6th day in Tasmania and I've sort of settled in well. The first night was tough, having had close to no control over the circumstances through which I ended up here. But the hospital administrative and clinical staff have been incredibly nice and supportive, much more so than in Sydney so I am beginning to have more optimism about this year. I think the hardest thing about coming here has been leaving all my friends behind in Sydney. Despite the many times I've tried to convince myself that even if I were in Sydney we wouldn't be seeing that much of each other anyway, it still doesn't really feel the same - being unable to just call up Sarah to see if she'd like to meet for a meal the next day, or receiving random texts from Candice when she happens to be close to POWH. It's been less than a week here and already one Canadian girl has dropped out of the program to re

I may be leaving for Tasmania tomorrow! It is nice to be starting work, and being away from Sydney for a year will probably be good for me but as always, it is hard to leave friends behind. I've been talking to/hanging out with Zubair (and Kaiv) a lot over the past month and I don't know how friendships can develop so quickly but I will miss those two a lot in Tassie.