During this last job I've committed two cardinal sins; faux pas like no other.
The first was when one of the big bosses asked me if my boots fitted well... and lo and behold I was indeed wearing his boots, into his own OT.
Sigh.
The second was this morning during the last Grandest, Biggest, attended-by-all-est ward round thingie of the firm.
The Professor Head of Department person was regaling us all with words of wisdom about how to discern people who want to blame their STDs on other people by asking them if they believed herpes is transmitted on toilet seat covers, when re-minisce thoughtlessly blurted out (and apparently quite loudly too) That's from House!
The Prof turns on re-minisce and looks sheepish and suddenly re-mi is imagining all sorts of unpleasant things happening to him in the span of a day, including iron maidens and torture racks.
Never, never. Never steal your Head of Deparment's thunder during his Grand, Grand Round...
Friday, October 31, 2008
Thursday, October 30, 2008
Walker
Had drinks with an old friend and her hubby last night. It was good to see her again; some fragment of a past that almost feels like it no longer belongs to me; a time when things were simpler.
I was returning her some glasses (read : beer mugs) she'd passed me for safekeeping when she left the UK.
Somewhere in the pile I found a mug that my mum had apparently secreted away from me.
It looked naggingly familiar; took a little bit of thought to breach the barriers of time and senility, and then the suppressed memories returned and I remembered who had given it to me, as a birthday present, a lifetime ago.
The Other side - why do you need a reason? Gary Larson. Who else.
I'd never drunk from it before. Figured, what the hell; nothing really matters anymore, nothing. And so I did, for the first time in my life; a cup of 100% proof non-alcoholic tea at Klee, and it was sweet.
Turned the cup over idly as we talked, and realised I'd never really looked closely at it before as I read : product of New South Wales, Australia.
Always assumed it'd been bought for me while She was back here; never expected that it had once travelled the friendly skies with a personal medical escort.
*****
Seems Gmail is so intelligent it now tries to protect us from emotionally destabilizing emails.
Remember some years back they revealed their secret behind gmail's success - pigeonrank.
*****
...---...
And so, during the brief fifteen minutes that is my lunch break today I find myself walking out of hospital, just walking. I want to walk as far away as I can, just keep walking, and walking. And I need a double-shot whisky so, so bad. And I don't want to turn around ever. Can't let them see my eyes.
But the old man is in clinic, alone, and he needs the help. Fucking responsibility.
Duty calls, and I have to answer, as much as I feel like I can't.
Closest thing to a whisky, teh ahlia. Nothing alcoholic within range of the hospital at this hour anyway.
So here I am. This is me, drowning in the infinity queue.
*****
I remember messaging MM to ask what she made of a guy out alone having a drink on a friday evening, too devil may carish to bother seeking company; she made it fear of rejection; that actually made me laugh. But she doesn't understand, unsurprisingly since I haven't said anything vaguely revealing.
Well that moment's here again; I need a drink bad; I need to be alone.
I was returning her some glasses (read : beer mugs) she'd passed me for safekeeping when she left the UK.
Somewhere in the pile I found a mug that my mum had apparently secreted away from me.
It looked naggingly familiar; took a little bit of thought to breach the barriers of time and senility, and then the suppressed memories returned and I remembered who had given it to me, as a birthday present, a lifetime ago.
The Other side - why do you need a reason? Gary Larson. Who else.
I'd never drunk from it before. Figured, what the hell; nothing really matters anymore, nothing. And so I did, for the first time in my life; a cup of 100% proof non-alcoholic tea at Klee, and it was sweet.
Turned the cup over idly as we talked, and realised I'd never really looked closely at it before as I read : product of New South Wales, Australia.
Always assumed it'd been bought for me while She was back here; never expected that it had once travelled the friendly skies with a personal medical escort.
*****
Seems Gmail is so intelligent it now tries to protect us from emotionally destabilizing emails.
Remember some years back they revealed their secret behind gmail's success - pigeonrank.
*****
...---...
And so, during the brief fifteen minutes that is my lunch break today I find myself walking out of hospital, just walking. I want to walk as far away as I can, just keep walking, and walking. And I need a double-shot whisky so, so bad. And I don't want to turn around ever. Can't let them see my eyes.
But the old man is in clinic, alone, and he needs the help. Fucking responsibility.
Duty calls, and I have to answer, as much as I feel like I can't.
Closest thing to a whisky, teh ahlia. Nothing alcoholic within range of the hospital at this hour anyway.
So here I am. This is me, drowning in the infinity queue.
*****
I remember messaging MM to ask what she made of a guy out alone having a drink on a friday evening, too devil may carish to bother seeking company; she made it fear of rejection; that actually made me laugh. But she doesn't understand, unsurprisingly since I haven't said anything vaguely revealing.
Well that moment's here again; I need a drink bad; I need to be alone.
Tuesday, October 28, 2008
Of the dead, From the dead
Distinguished mediocrity returns, angry no longer.
I can't help but remember my first, as well.
*****
I think she was in her late forties, although she looked to be in her sixties. She was very frail, but wise and kindly, and she had a sparkle in her eye.
She was in with us for a collection of pus in the space between her lung and her chest wall, which we call an empyema.
I remember my registrar bringing his not-so-wide-eyed (I've always had sleepy eyes) houseman through the catheter insertion to drain the empyema. My registrar was a great guy, shy, quiet middle eastern, immensely patient, goateed and mustachiod, looking a little like a dark-skinned, black-haired Santa Claus sans the big bellied laugh, if you can imagine it. She took the procedure like a trooper, laughing it off gaily after the deed was done.
My consultant was an incredibly good-looking and charismatic Scotsman with a very square jaw, who at 65 still infuriatingly turned the heads of all the women in the hospital. Women from the very young to the geriatric would swoon and wet themselves as he walked past, collar button undone and jacket jauntily slung over his shoulder. I remember hearing about him telling an emergency department nurse to take her top off, at a departmental rave/party thing in some club. I wasn't there to see it, but apparently she did, in front of everyone.
Shrug. Those were the days. Not quite clean, but good harmless fun.
Boss used to wander around on his round holding animated discussions about the Fooking NHS, and its Fooked up (blahblah).
Everybody loved him.
I don't remember her name now, but I remember that I broke the First Rule and became personally involved. She was kind, and sweet, and we would chat for ages - the life of a live-in houseman without a life... I had all the time in the world, and nowhere to go after work, and what the hell, all the other housemen were living in too. I didn't have anyone to rush off to, and the one girl (another doctor) I vaguely fancied who I would flirt with a little, and who would flirt back with me was living on site too. So, shrug.
I got her a book to read on the ward, because she was obviously getting bored; I remember her being happy to receive it. Sometimes she used to joke that I was so handsome, and I think I either used to joke that she was going blind, or senile.
The day it happened, I was pottering around the hospital; I think I was in the corridors walking back to my room, when one of the registrars called me; her name was Adeline I think. It's been a while. Adeline was BBC and oh-so-cool, and I always had rather neutral, bordering on bad vibes from her.
She told me that I had better go see my patient, although it was long after-hours and she had no right to.
I made my way with haste back up to the ward, and found her unconscious and gasping for breath. The ward nurse (a lovely middle aged woman who was... a friend, and who knew just-how Re-mi liked his tea made, sweet as sin and so thick you can stand your teaspoon up in it) wordlessly shoved the casenotes into my stunned hands, and I read...
She had dropped her blood pressure suddenly and become unresponsive, the cardiac arrest team led by Adeline was called, started iv fluids, blood pressure returned, and then they pretty much buggered off after calling the team houseman to come see his patient.
I put my finger on her pulse, and it stopped right there and then.
And then everything became a wild panic, as I started CPR, and my nurse began to bag her, and I shouted for someone to call the crash team back.
You just don't. You don't see a patient peri-arrest, and then leave her to die. I'll never forget the sheer hatred I felt then for Adeline.
The crash team returned and we tubed and got her back after half an hour, but after we called the Boss he decided that she had likely had a pulmonary embolism or some such, and that there was just no point going on. Pull the plug.
And then they were gone again, and it was just me standing over her corpse, feeling... defeated. broken. And saying a last prayer for her soul, putting my hand mechanically on her carotid to document - time of death, xx:xx. No pulse, no heart sounds, no breath sounds, no response to pain, pupils fixed and unreactive to light.
Goodbye, Mrs X
I can't help but remember my first, as well.
*****
I think she was in her late forties, although she looked to be in her sixties. She was very frail, but wise and kindly, and she had a sparkle in her eye.
She was in with us for a collection of pus in the space between her lung and her chest wall, which we call an empyema.
I remember my registrar bringing his not-so-wide-eyed (I've always had sleepy eyes) houseman through the catheter insertion to drain the empyema. My registrar was a great guy, shy, quiet middle eastern, immensely patient, goateed and mustachiod, looking a little like a dark-skinned, black-haired Santa Claus sans the big bellied laugh, if you can imagine it. She took the procedure like a trooper, laughing it off gaily after the deed was done.
My consultant was an incredibly good-looking and charismatic Scotsman with a very square jaw, who at 65 still infuriatingly turned the heads of all the women in the hospital. Women from the very young to the geriatric would swoon and wet themselves as he walked past, collar button undone and jacket jauntily slung over his shoulder. I remember hearing about him telling an emergency department nurse to take her top off, at a departmental rave/party thing in some club. I wasn't there to see it, but apparently she did, in front of everyone.
Shrug. Those were the days. Not quite clean, but good harmless fun.
Boss used to wander around on his round holding animated discussions about the Fooking NHS, and its Fooked up (blahblah).
Everybody loved him.
I don't remember her name now, but I remember that I broke the First Rule and became personally involved. She was kind, and sweet, and we would chat for ages - the life of a live-in houseman without a life... I had all the time in the world, and nowhere to go after work, and what the hell, all the other housemen were living in too. I didn't have anyone to rush off to, and the one girl (another doctor) I vaguely fancied who I would flirt with a little, and who would flirt back with me was living on site too. So, shrug.
I got her a book to read on the ward, because she was obviously getting bored; I remember her being happy to receive it. Sometimes she used to joke that I was so handsome, and I think I either used to joke that she was going blind, or senile.
The day it happened, I was pottering around the hospital; I think I was in the corridors walking back to my room, when one of the registrars called me; her name was Adeline I think. It's been a while. Adeline was BBC and oh-so-cool, and I always had rather neutral, bordering on bad vibes from her.
She told me that I had better go see my patient, although it was long after-hours and she had no right to.
I made my way with haste back up to the ward, and found her unconscious and gasping for breath. The ward nurse (a lovely middle aged woman who was... a friend, and who knew just-how Re-mi liked his tea made, sweet as sin and so thick you can stand your teaspoon up in it) wordlessly shoved the casenotes into my stunned hands, and I read...
She had dropped her blood pressure suddenly and become unresponsive, the cardiac arrest team led by Adeline was called, started iv fluids, blood pressure returned, and then they pretty much buggered off after calling the team houseman to come see his patient.
I put my finger on her pulse, and it stopped right there and then.
And then everything became a wild panic, as I started CPR, and my nurse began to bag her, and I shouted for someone to call the crash team back.
You just don't. You don't see a patient peri-arrest, and then leave her to die. I'll never forget the sheer hatred I felt then for Adeline.
The crash team returned and we tubed and got her back after half an hour, but after we called the Boss he decided that she had likely had a pulmonary embolism or some such, and that there was just no point going on. Pull the plug.
And then they were gone again, and it was just me standing over her corpse, feeling... defeated. broken. And saying a last prayer for her soul, putting my hand mechanically on her carotid to document - time of death, xx:xx. No pulse, no heart sounds, no breath sounds, no response to pain, pupils fixed and unreactive to light.
Goodbye, Mrs X
Monday, October 27, 2008
No Air
This is me, post-call at the gym running for my life. Running nowhere, going nowhere - no escape here from the madness of the world, but just a little piece of peace. Running from the thoughts and conversations and memories in my head, which circle endlessly and pointlessly, like wolves locked in combat; running from the realities of the world past, and present.
Running from the truth - that there is no reason; none at all, for the way things happen, happened, and will continue to happen.
Staring out at the skyline, looking at nothing in particular, hearing only the beat of the music, feeling only the beat of my feet and the music - the music - without a drink in my hand. (I understand now, vaya.)
Freewheeling.
Running, then sprinting until I have to stop, for air.
That's why I run -
all that I have
thirty minutes
*****
No new thoughts in my head, no catherses.
Time to stop running; reality check.
Nobody died for us. I guess I always knew the truth; I should have known the first time you said you weren't sure. We should have stopped, then and there. I should have walked away before it happened.
There wouldn't have been a need for... untruth.
The sharpest stick, the harshest knife. The most painful wound in my stupid mind.
Reality check.
I was in control.
The events that transpired, a consequence of my own fault.
I don't blame you, nor myself.
There's no reason for the world.
*****
Re-minisce, once synonymous with "A need for truth", now "from the ashes, to the ashes"
Once read by a large following, once the recipient of many strangers' comments and opinions.
Now read by a select few. No real change, still obstinately... seeking truth.
Anyone remember : Truth, love, courage. The way of the Avatar?
Tenets of a computer game from once upon a lifetime ago. Just a computer game.
Uncool, conservative beliefs fast tarnishing and fading in a broken, insane world.
I remember lying on the couch with Grace as the world fell down around me, with my head in her lap as she stroked my hair, just breathing, just breathing; taking shelter for a while from the fucked up state of the hospital, the country, the world.
And then there was you, thinking about coming home to die in slumber as I drove home after a long day's work, and then after, the promise of dinner, or television, and just peace.
Shelter from the world; a moment's quiet, without thought.
These fragile homes we built, that gave us roofs over our heads from the evil and darkness around us; then the walls came crumbling down, as reality crept into our worlds.
I'm still me.
I still burn for truth.
I still dream of peace, someday shelter - but not in someone; my mistake twice now.
When the time comes I will flee the insanity of this place, the insiduous madness that creeps into your soul, a day at a time.
Flee back to a place where the darkness is tangible, and easy to see; easy for me to keep at bay. Easy for me, alone, on my own to keep out of my soul.
I remember a place like that once, from a lifetime ago.
I remember being stalked as I walked home late at night, the hands in the jackets, the quickening footsteps, and then just as it sank in and I tensed to run, the police-car that drove by, and the sudden change in direction of my pursuers.
Easy then, black and white.
I remember you, though not your name - the blonde who asked outrageous questions in front of our patients about oriental pubic hair, who sat in my lap in the rest room to make me squirm, I remember us both slightly drunk, the pounding music, drawing closer to talk, till our foreheads touched and our noses brushed, and we smiled; I knew the moment, I knew the script.
I knew that I did not feel, and that this was not for me.
I pulled away.
I remember you, the pretty student nurse on my ward with that sharp, sassy tongue, and I remember the seven other faceless students forcing us both to dance; I knew what it meant; and so we danced, and then I left.
Easy then to just laugh, to enjoy oneself, to know when to turn away.
*****
Let us hypothesize, for a moment, theorize, conjecture, postulate.
Let's sit down like gentleman, civilly, clinically, coldly, detachedly over a cup of tea shall we? You can be the mad hatter, and I'll be the white rabbit.
*****
A young lady is brought into our imaginary emergency department. We document : lives alone. accompanied by her mother.
All stories start at the beginning ; we note a history of vomiting brownish fluids for five days with giddiness and poor oral intake. We note that she is uncooperative and does not respond to questions.
We elicit a story of a ?thyroid problem diagnosed on health screening just over a weekago, initially treated with a medication which was stopped.
The media, oddly has a different story, of an acute severe headache, of a sudden collapse at work. ("fainting") Things suggestive of an acute problem resulting in immediate confusion. Odd.
Our nurses document a pain score of five to six - only in the moderate range, not severe. One wonders how difficult it must be to elicit an objective pain score from a confused patient.
It slips our minds to write down where the pain is of - the head? the abdomen? Everywhere paining?
The media writes that it is difficult for the girl to keep her eyes open. The clinical record makes no mention of this. Would it have made a difference? Perhaps not. Or perhaps a bright spark might have called this "photophobia". Who knows?
On physical examination, she is uncooperative, not responding, lying hunched over on her side, vomiting brown fluid and salivating.
She is not febrile 36.8 degrees, but hypertensive (170/70), she is borderline tachycardic with a HR of 97. Her saturations on room air are normal and she is not tachypnoeic.
She is deemed fairly hydrated (we write down that her hands are dry... it must be pertinent, somehow. must be.)
We elicit bilaterally reactive 2mm pupils, and equal limb movements on all sides, but oddly make no effort to perform a Glasgow Coma Scale (? are her eyes open? E4? or only to noise? E3? Perhaps not at all? E1? She doesn't respond to questions... is she V1? She is uncooperative - is she M1? or M5? Let's be generous, let's call her an E4, V2 M5. 11/15... in short, a rather ill young lady.)
Her lungs are clear.
Her abdomen is soft and non tender and digital rectal examination is normal.
Her capillary blood sugar is 8, and ECG shows sinus tachycardia
We send and await bloods, thyroid function tests are severely deranged :
TSH is < 0.05, total T4 is 99 - absurdedly high.
The rest of the bloods show only a mild neutrophilia and total whites of 11. Electrolytes are normal, liver function tests are acceptable, and a urine pregnancy test is negative.
Chest X ray is normal.
The diagnosis becomes evident - severe thyrotoxicosis. Relief all around; till this moment we have no idea what we're dealing with.
The GP who saw her a week ago was correct, something is wrong with her thyroid, and the numbers and her clinical picture, with obvious confusion tell us a story of
something being very, very wrong.
We correctly realise we are out of our depths - this condition is rare, the stuff that only textbooks remember; we consult a senior opinion out of concern - this may be thyroid storm, this may be something that can kill. Perhaps worthy of an intensive care bed.
The senior opinion, as is often the case, does not tell us what they think this is, but what to do : put her on the general ward, in a bed next to the nursing station.
If we take the time to risk stratify her, she falls in the category of "impending thyroid storm". It is a brave, but perhaps arguably reasonable decision to place her on the general ward; treatment is correctly started for thyrotoxicosis. Propranolol (for a fast heart rate) and propiothiouracil, to knock back the hyperthyroidism. IV hydrocortisone and iv fluids.
Blood tests will later confirm that she has Grave's disease - TSH receptor antibodies return positive. Autoimmunity at its worst.
The ward staff document that she stays alone, and has shifted out from her parental home for some time now. She is an ex smoker with no known history of recreational drug use. They note that she looks depressed and non-communicative.
She seems depressed and non-communicative, and she is again uncooperative - we can only assume they refer to her depressed level of awareness of the world around her; people who don't communicate much may seem depressed. Or perhaps their sensoriums are just clouded by the toxins running through their blood. She is normotensive and mildly tachycardic 108 on the ward.
She is seen by an intensivist and treatment continued.
She abruptly becomes unresponsive and starts foaming at the mouth in the middle of the night. ECG shows asystole. The impression then is of pulmonary oedema. She is intubated, and CPR commenced, but the resusc team fails to revive her, despite what is most likely very good quality CPR for an acceptable duration.
No air.
A bedtime story for doctors that nightmares are made of; this didn't happen of course.
The show stopper : autopsy reveals some form of intracranial haemorrhage.
And now for the intellectual discussion :
Would you have scanned her?
There was no definite indication to; blood tests pointed clearly towards a diagnosis of thyroid storm.
Ah, you say, but doctors should not be ruled by blood tests, but by clinical intuition.
Her poor GCS (which was not apparently documented) could have been attributed to severe thyrotoxicosis.
It is forgivable to have not scanned her. Consensus medical opinion will conclude this, in a court of law. Online reports of similar cases note "CT brain may be done if the diagnosis is in doubt". We argue that the diagnosis was not in doubt.
But on the balance of things, a young twenty six year old girl now lies dead and her family, shattered. Perhaps there were concurrent pathologies, who can say.
Would you have scanned her, even if it was "bad medicine"?
Who knows. Perhaps a clearly documented falling GCS despite treatment would have prompted a scan. Who knows. Perhaps a clearly documented neurological examination would have prompted a scan. Who knows. Perhaps not, perhaps the GCS would simply have fluctuated, or perhaps the neuro exam would have been unhelpful or equivocal.
Perhaps the GCS was charted, we just failed to ascertain that.
What is concrete remain the grossly abnormal TSH and free T4.
Would you have put her on an intensive care unit, or perhaps a high dependency unit for close monitoring?
Who can say, perhaps there were no beds available, perhaps impending thyroid storm can be less drastically managed - these are the mysterious realms of specialist endocrinologists.
Why was the media's story so different from the official record?
Perhaps, if we were to go out on a limb we might postulate thyroid storm in a hyperthyroid patient precipitated by an acute-onset intracranial haemorrhage - who can tell?
What is real is that this hypothetical young woman will fade from hypothetical memory tomorrow, and that there will be no take home message for anyone.
What is real is that this truth will be lost with time.
What is real is that this imaginary girl's family will be made - unjustly - to feel guilty that they omitted to mention her minor head injury (walked into a glass door, didnt suffer any symptoms whatsoever) a month before - what is sad is that the media, which has, since this is fiction, done a godawful job of presenting facts, but instead garnered data from sources likely emotional and unreliable - distraught relatives : will have nailed the diagnosis on this imaginary girl's coffin. A bleed in the brain secondary to trivial head injury.
Just an unfortunate turn of events, sometimes there's just... no reason.
An imaginary bedtime story to amuse ourselves with, a piece of fiction from an idle mind.
There is no grain of truth here, there are only academic questions.
Running from the truth - that there is no reason; none at all, for the way things happen, happened, and will continue to happen.
Staring out at the skyline, looking at nothing in particular, hearing only the beat of the music, feeling only the beat of my feet and the music - the music - without a drink in my hand. (I understand now, vaya.)
Freewheeling.
Running, then sprinting until I have to stop, for air.
That's why I run -
all that I have
thirty minutes
*****
No new thoughts in my head, no catherses.
Time to stop running; reality check.
Nobody died for us. I guess I always knew the truth; I should have known the first time you said you weren't sure. We should have stopped, then and there. I should have walked away before it happened.
There wouldn't have been a need for... untruth.
The sharpest stick, the harshest knife. The most painful wound in my stupid mind.
Reality check.
I was in control.
The events that transpired, a consequence of my own fault.
I don't blame you, nor myself.
There's no reason for the world.
*****
Re-minisce, once synonymous with "A need for truth", now "from the ashes, to the ashes"
Once read by a large following, once the recipient of many strangers' comments and opinions.
Now read by a select few. No real change, still obstinately... seeking truth.
Anyone remember : Truth, love, courage. The way of the Avatar?
Tenets of a computer game from once upon a lifetime ago. Just a computer game.
Uncool, conservative beliefs fast tarnishing and fading in a broken, insane world.
I remember lying on the couch with Grace as the world fell down around me, with my head in her lap as she stroked my hair, just breathing, just breathing; taking shelter for a while from the fucked up state of the hospital, the country, the world.
And then there was you, thinking about coming home to die in slumber as I drove home after a long day's work, and then after, the promise of dinner, or television, and just peace.
Shelter from the world; a moment's quiet, without thought.
These fragile homes we built, that gave us roofs over our heads from the evil and darkness around us; then the walls came crumbling down, as reality crept into our worlds.
I'm still me.
I still burn for truth.
I still dream of peace, someday shelter - but not in someone; my mistake twice now.
When the time comes I will flee the insanity of this place, the insiduous madness that creeps into your soul, a day at a time.
Flee back to a place where the darkness is tangible, and easy to see; easy for me to keep at bay. Easy for me, alone, on my own to keep out of my soul.
I remember a place like that once, from a lifetime ago.
I remember being stalked as I walked home late at night, the hands in the jackets, the quickening footsteps, and then just as it sank in and I tensed to run, the police-car that drove by, and the sudden change in direction of my pursuers.
Easy then, black and white.
I remember you, though not your name - the blonde who asked outrageous questions in front of our patients about oriental pubic hair, who sat in my lap in the rest room to make me squirm, I remember us both slightly drunk, the pounding music, drawing closer to talk, till our foreheads touched and our noses brushed, and we smiled; I knew the moment, I knew the script.
I knew that I did not feel, and that this was not for me.
I pulled away.
I remember you, the pretty student nurse on my ward with that sharp, sassy tongue, and I remember the seven other faceless students forcing us both to dance; I knew what it meant; and so we danced, and then I left.
Easy then to just laugh, to enjoy oneself, to know when to turn away.
*****
Let us hypothesize, for a moment, theorize, conjecture, postulate.
Let's sit down like gentleman, civilly, clinically, coldly, detachedly over a cup of tea shall we? You can be the mad hatter, and I'll be the white rabbit.
*****
A young lady is brought into our imaginary emergency department. We document : lives alone. accompanied by her mother.
All stories start at the beginning ; we note a history of vomiting brownish fluids for five days with giddiness and poor oral intake. We note that she is uncooperative and does not respond to questions.
We elicit a story of a ?thyroid problem diagnosed on health screening just over a weekago, initially treated with a medication which was stopped.
The media, oddly has a different story, of an acute severe headache, of a sudden collapse at work. ("fainting") Things suggestive of an acute problem resulting in immediate confusion. Odd.
Our nurses document a pain score of five to six - only in the moderate range, not severe. One wonders how difficult it must be to elicit an objective pain score from a confused patient.
It slips our minds to write down where the pain is of - the head? the abdomen? Everywhere paining?
The media writes that it is difficult for the girl to keep her eyes open. The clinical record makes no mention of this. Would it have made a difference? Perhaps not. Or perhaps a bright spark might have called this "photophobia". Who knows?
On physical examination, she is uncooperative, not responding, lying hunched over on her side, vomiting brown fluid and salivating.
She is not febrile 36.8 degrees, but hypertensive (170/70), she is borderline tachycardic with a HR of 97. Her saturations on room air are normal and she is not tachypnoeic.
She is deemed fairly hydrated (we write down that her hands are dry... it must be pertinent, somehow. must be.)
We elicit bilaterally reactive 2mm pupils, and equal limb movements on all sides, but oddly make no effort to perform a Glasgow Coma Scale (? are her eyes open? E4? or only to noise? E3? Perhaps not at all? E1? She doesn't respond to questions... is she V1? She is uncooperative - is she M1? or M5? Let's be generous, let's call her an E4, V2 M5. 11/15... in short, a rather ill young lady.)
Her lungs are clear.
Her abdomen is soft and non tender and digital rectal examination is normal.
Her capillary blood sugar is 8, and ECG shows sinus tachycardia
We send and await bloods, thyroid function tests are severely deranged :
TSH is < 0.05, total T4 is 99 - absurdedly high.
The rest of the bloods show only a mild neutrophilia and total whites of 11. Electrolytes are normal, liver function tests are acceptable, and a urine pregnancy test is negative.
Chest X ray is normal.
The diagnosis becomes evident - severe thyrotoxicosis. Relief all around; till this moment we have no idea what we're dealing with.
The GP who saw her a week ago was correct, something is wrong with her thyroid, and the numbers and her clinical picture, with obvious confusion tell us a story of
something being very, very wrong.
We correctly realise we are out of our depths - this condition is rare, the stuff that only textbooks remember; we consult a senior opinion out of concern - this may be thyroid storm, this may be something that can kill. Perhaps worthy of an intensive care bed.
The senior opinion, as is often the case, does not tell us what they think this is, but what to do : put her on the general ward, in a bed next to the nursing station.
If we take the time to risk stratify her, she falls in the category of "impending thyroid storm". It is a brave, but perhaps arguably reasonable decision to place her on the general ward; treatment is correctly started for thyrotoxicosis. Propranolol (for a fast heart rate) and propiothiouracil, to knock back the hyperthyroidism. IV hydrocortisone and iv fluids.
Blood tests will later confirm that she has Grave's disease - TSH receptor antibodies return positive. Autoimmunity at its worst.
The ward staff document that she stays alone, and has shifted out from her parental home for some time now. She is an ex smoker with no known history of recreational drug use. They note that she looks depressed and non-communicative.
She seems depressed and non-communicative, and she is again uncooperative - we can only assume they refer to her depressed level of awareness of the world around her; people who don't communicate much may seem depressed. Or perhaps their sensoriums are just clouded by the toxins running through their blood. She is normotensive and mildly tachycardic 108 on the ward.
She is seen by an intensivist and treatment continued.
She abruptly becomes unresponsive and starts foaming at the mouth in the middle of the night. ECG shows asystole. The impression then is of pulmonary oedema. She is intubated, and CPR commenced, but the resusc team fails to revive her, despite what is most likely very good quality CPR for an acceptable duration.
No air.
A bedtime story for doctors that nightmares are made of; this didn't happen of course.
The show stopper : autopsy reveals some form of intracranial haemorrhage.
And now for the intellectual discussion :
Would you have scanned her?
There was no definite indication to; blood tests pointed clearly towards a diagnosis of thyroid storm.
Ah, you say, but doctors should not be ruled by blood tests, but by clinical intuition.
Her poor GCS (which was not apparently documented) could have been attributed to severe thyrotoxicosis.
It is forgivable to have not scanned her. Consensus medical opinion will conclude this, in a court of law. Online reports of similar cases note "CT brain may be done if the diagnosis is in doubt". We argue that the diagnosis was not in doubt.
But on the balance of things, a young twenty six year old girl now lies dead and her family, shattered. Perhaps there were concurrent pathologies, who can say.
Would you have scanned her, even if it was "bad medicine"?
Who knows. Perhaps a clearly documented falling GCS despite treatment would have prompted a scan. Who knows. Perhaps a clearly documented neurological examination would have prompted a scan. Who knows. Perhaps not, perhaps the GCS would simply have fluctuated, or perhaps the neuro exam would have been unhelpful or equivocal.
Perhaps the GCS was charted, we just failed to ascertain that.
What is concrete remain the grossly abnormal TSH and free T4.
Would you have put her on an intensive care unit, or perhaps a high dependency unit for close monitoring?
Who can say, perhaps there were no beds available, perhaps impending thyroid storm can be less drastically managed - these are the mysterious realms of specialist endocrinologists.
Why was the media's story so different from the official record?
Perhaps, if we were to go out on a limb we might postulate thyroid storm in a hyperthyroid patient precipitated by an acute-onset intracranial haemorrhage - who can tell?
What is real is that this hypothetical young woman will fade from hypothetical memory tomorrow, and that there will be no take home message for anyone.
What is real is that this truth will be lost with time.
What is real is that this imaginary girl's family will be made - unjustly - to feel guilty that they omitted to mention her minor head injury (walked into a glass door, didnt suffer any symptoms whatsoever) a month before - what is sad is that the media, which has, since this is fiction, done a godawful job of presenting facts, but instead garnered data from sources likely emotional and unreliable - distraught relatives : will have nailed the diagnosis on this imaginary girl's coffin. A bleed in the brain secondary to trivial head injury.
Just an unfortunate turn of events, sometimes there's just... no reason.
An imaginary bedtime story to amuse ourselves with, a piece of fiction from an idle mind.
There is no grain of truth here, there are only academic questions.
Sunday, October 26, 2008
Lamb for the slaughter
it's not everyday that lambs fall from the sky, and then voluntarily profer themselves up to be served as the main course...
and so re-minisce finds himself bemused to have unexpectedly acquired a potential "surrogate wife" for the hospital dinner and dance.
Two reasons for the bemusement :
One - The "recruit" isn't one of the old "regulars", only persuaded after much wailing and pleading and promises of free drinks for a lifetime... but an extremely new friend, who...
Two - ... volunteered , and was not enlisted, or for that matter, even solicited.
Truly, compassion is a wonderous thing.
and so re-minisce finds himself bemused to have unexpectedly acquired a potential "surrogate wife" for the hospital dinner and dance.
Two reasons for the bemusement :
One - The "recruit" isn't one of the old "regulars", only persuaded after much wailing and pleading and promises of free drinks for a lifetime... but an extremely new friend, who...
Two - ... volunteered , and was not enlisted, or for that matter, even solicited.
Truly, compassion is a wonderous thing.
Wednesday, October 22, 2008
Salvation lies in the bottom of a cocktail glass
I needed a place to change out of uniform.
It was on my way home.
I need a drink.
Some random girl told me I was taking an awfully long time to finish my drink as I nursed it morosely in my hand, a million miles away in my head, replaying nothing in particular over and over again.
Nothing makes sense right now.
Yes, I recognise the signs.
*****
that's just the way it is (and so it is / just like you said it would be)
no calling for help, no miraculous ess oh ess rescue mes; no portals to the past, no raging against the machine.
life goes on.
Someone wise told me this : breathe, just breathe; be still, remember you.
I'll hand down to you those same words she gave me : perhaps you'll make a better job of it than I did.
my salvation lies in a glass.
It was on my way home.
I need a drink.
Some random girl told me I was taking an awfully long time to finish my drink as I nursed it morosely in my hand, a million miles away in my head, replaying nothing in particular over and over again.
Nothing makes sense right now.
Yes, I recognise the signs.
*****
that's just the way it is (and so it is / just like you said it would be)
no calling for help, no miraculous ess oh ess rescue mes; no portals to the past, no raging against the machine.
life goes on.
Someone wise told me this : breathe, just breathe; be still, remember you.
I'll hand down to you those same words she gave me : perhaps you'll make a better job of it than I did.
my salvation lies in a glass.
Monday, October 20, 2008
En Passant
When death strikes prematurely it always comes as a shock.
Our first instinct is invariably disbelief, then perhaps, variably anger, denial, regret, remorse. Guilt.
Kubler Ross described the bereavement reaction at length. I personally think it's all rubbish, with a bit of truth mixed in. It all depends on our relationship with the person, and on how we interacted with them, if at all.
******************************
I remember my best friend from primary school, Junlong.
He had a large head and very short hair, and he wore spectacles. He had a kindly face. I think we were classmates from primary two to three. I changed class each year, so that must mean he promoted up with me.
The last words I spoke to him were, if memory serves me correctly, "don't worry, I'll never get in" (wrt some stupid IQ test thingie that resulted in me being snatched out of my school and unceremoniously implanted into another)
I met him again three years later, our mothers were both walking us, somewhere near farrer road. We waved at each other and smiled.
I read his obituary in the papers a few days later. And then I read the front page article about how he got mowed down by a bus, crossing out from behind a waiting taxi into traffic.
I was very young, and at the time not quite in touch with anything vaguely resembling emotions. And yet I knew I had to attend his funeral; it was only proper.
The mother refused to let me go; I was too young and had to be protected from these kinds of things.
And that was the end of that.
In her mind, anyway.
Guilt.
*******************************************
My neighbours daughter died when she was in her teens; she was a national gymnast, and really quite pretty.
I didn't know her very well, save what I read in the newspapers about her once in a blue moon, and from our brief interactions in her mums garden when the mothers would get together to enthuse about roses, and leave the two teenagers planted neglected in the flowerbeds.
We used to shyly roll our eyes in exasperation at each other, at our uncool mothers.
She was struck down by leukaemia - or rather, by overwhelming sepsis post bone marrow transplant. I have vague recollections of the organism in question being Epstein Barr.
The word amongst the doctors was that she was nearly at her window period, beyond which her immune system would have been expected to protect her against infection again.
These days, I'm a little older and know that the window period is arbitrary; it was just one of those things; bad luck, bad timing, and perhaps a stolen kiss.
Depression
**********************************************
From : The Electronic New Paper
**************************************************
I never knew Miss Sai Fengmin, but she was a friend of a friend.
Sometimes I really hate the way the media sensationalizes everything with what little knowledge that they have - while revealing the truth, quite by accident.
Sudden, severe (? "thunderclap" ?? )headache - in extremis.
Loss of consciousness.
Giddiness, lethargy.
Nausea and vomiting.
Photophobia.
I really don't think that the family should have been made to feel guilty about omitting to mention the minor head trauma a month ago.
I don't have all the facts here.
But ask any medical student to put the signs together, as written in the newspaper.
Any student.
It's pass-fail viva stuff. And then ask them what must be done next.
And then all sorts of questions begin to spring up, which I shan't alude to. I know what happens to people like me, who even begin to write what I've written.
Troubled
More Troubled
*******
Our first instinct is invariably disbelief, then perhaps, variably anger, denial, regret, remorse. Guilt.
Kubler Ross described the bereavement reaction at length. I personally think it's all rubbish, with a bit of truth mixed in. It all depends on our relationship with the person, and on how we interacted with them, if at all.
******************************
I remember my best friend from primary school, Junlong.
He had a large head and very short hair, and he wore spectacles. He had a kindly face. I think we were classmates from primary two to three. I changed class each year, so that must mean he promoted up with me.
The last words I spoke to him were, if memory serves me correctly, "don't worry, I'll never get in" (wrt some stupid IQ test thingie that resulted in me being snatched out of my school and unceremoniously implanted into another)
I met him again three years later, our mothers were both walking us, somewhere near farrer road. We waved at each other and smiled.
I read his obituary in the papers a few days later. And then I read the front page article about how he got mowed down by a bus, crossing out from behind a waiting taxi into traffic.
I was very young, and at the time not quite in touch with anything vaguely resembling emotions. And yet I knew I had to attend his funeral; it was only proper.
The mother refused to let me go; I was too young and had to be protected from these kinds of things.
And that was the end of that.
In her mind, anyway.
Guilt.
*******************************************
My neighbours daughter died when she was in her teens; she was a national gymnast, and really quite pretty.
I didn't know her very well, save what I read in the newspapers about her once in a blue moon, and from our brief interactions in her mums garden when the mothers would get together to enthuse about roses, and leave the two teenagers planted neglected in the flowerbeds.
We used to shyly roll our eyes in exasperation at each other, at our uncool mothers.
She was struck down by leukaemia - or rather, by overwhelming sepsis post bone marrow transplant. I have vague recollections of the organism in question being Epstein Barr.
The word amongst the doctors was that she was nearly at her window period, beyond which her immune system would have been expected to protect her against infection again.
These days, I'm a little older and know that the window period is arbitrary; it was just one of those things; bad luck, bad timing, and perhaps a stolen kiss.
Depression
**********************************************
From : The Electronic New Paper
'HEARTLAND HOTTIE' DIES IN SLEEP FROM BLEEDING IN BRAIN
No symptoms for 1 month after she hits head
By Elysa Chen
October 19, 2008
THAT self-assured smile, that slight tilt of the head captivated The New Paper's photographer Gavin Foo so much he snapped her picture.
And when it appeared in the 'Heartland Hottie' series in The New Paper on Sunday in March last year, it was, for Miss Sai Fengmin, one of the happiest moments in her 26 years of life.
Now, that smile, frozen in a photograph, is all that's left for her mother.
Holding up the picture, a teary Mrs Sai asked: 'Isn't my daughter pretty? She was so proud and happy that she was spotted for your Heartland Hotties section.'
Miss Sai died in her sleep on Thursday.
It was a shocking end to an inexplicable turn of events that began a month earlier, when she knocked her head against a glass door.
The marketing executive was visiting a friend at her new home when she knocked into a glass panel between the kitchen and the living room.
She didn't know then, but that seemingly innocuous bump may have resulted in an undetected brain injury that led to her death a month later.
There were few tell-tale signs that it was anything serious. No nausea or giddiness - common symptoms of a concussion - within the first two weeks.
But on Wednesday, four weeks after the accident, Miss Sai had a headache and fainted at work.
She was then admitted to Alexandra Hospital, where she died in her sleep early the next morning.
An autopsy showed she had died of an acute brain haemorrhage.
Describing her daughter as the 'most special' of her five children, Mrs Sai said: 'When my colleagues at work see the picture of my children at my desk, they would keep talking about how pretty and special my Min Min was.'
Mrs Sai declined to give her full name or her occupation.
The first sign that all was not well came at 10am on Wednesday morning when Miss Sai fainted at work.
Mrs Sai, who got a call from her daughter's colleagues, rushed to the office.
'My daughter kept saying she felt very giddy and wanted to sleep. She also kept vomiting something chocolate-coloured,' she said.
Mrs Sai called for an ambulance and rushed her daughter to Alexandra Hospital within 20 minutes.
Complained of pain
At the accident and emergency ward, Miss Sai kept thrashing around on the bed and complained of pain.
Mrs Sai said: 'She was still strong but she just didn't seem to be able to open her eyes.'
She had been told she had a thyroid problem by a GP a week earlier.
At the hospital, Miss Sai was kept under observation. But her symptoms had nothing to do with the thyroid problem, said Mrs Sai.
And no one told the doctors about the knock on the head.
She said: 'We were so focused on the thyroid problem that we forgot that it could have been because she had hit her head one month ago.'
Miss Sai had gone to a polyclinic the day after she hit her head. She was told to monitor her condition for two weeks and was given medical leave for one day.
Mrs Sai said the doctor told her that if she did not experience nausea or giddiness after two weeks, she should be fine.
She was due back at the polyclinic for her follow-up two weeks after the knock, but decided see a private doctor instead because she did not want to wait in the long queue.
It was then that the general practitioner found out that she had a thyroid problem.
Mrs Sai said: 'If they had not done an autopsy, I would still be telling everyone that she died of a thyroid problem.
'I can't believe that she was still joking about how the glass didn't break after she knocked into it.'
Mrs Sai had stayed with her daughter until 11pm on Wednesday.
At 3am on Thursday, the hospital called Miss Sai's family, informing them that she was experiencing breathing difficulties. Her family rushed to the hospital, but it was too late.
Her father, whose eyes were red from crying, said: 'We didn't even get to say goodbye to her.'
He was too distraught to continue.
According to a friend, she was his favourite daughter. He later said in Mandarin: 'She was a filial daughter, but she was often too shy to express it. She hid her love for us inside.'
Added Mrs Sai: 'She contributed to the household expenses and, as the oldest child, she voluntarily moved out of our four-room flat so that her brother and three sisters could have more space.
'She was so independent. She often travelled overseas on her own.'
Miss Sai, who rented an apartment with friends at Normanton Park in Alexandra, would visit her family at their Telok Blangah flat on weekends.
Mrs Sai said her daughter, an Arts graduate from the National University of Singapore, was a bright student who never needed tuition.
She had earlier attended Anglo-Chinese Junior College and Raffles Girls' School.
Describing her daughter as someone who treasured friendships, Mrs Sai said: 'I hope to hear from her friends. I want to hear about how she brought happiness to them and how she was always there for them.'
Holding up a souvenir showing the word 'bye' framed by a photocopy of Miss Sai's hand that she had made for colleagues as a farewell gesture when she left her former job, her paternal aunt, who wanted to be known only as Mrs Teo, said:
'She was such a creative girl, with such a bright future. We are going to miss her.'
--------------------------------------------------------------------------------
SUDDEN DEATH
LATE SEPT
Miss Sai knocks head against glass panel at friend's house. The next day, she sees a doctor and gets medical leave for a day.
6 OCT
She is diagnosed with thyroid problem at GP clinic.
15 OCT
10am: She has headache and faints at work. Reaches hospital at noon.
15 OCT
4pm: She is admitted to a B2 ward, then moved to B1 ward at 11pm after her mother asks for upgrade.
16 OCT
3am: Hospital calls family. They arrive at 3.30am, but Miss Sai is already dead.
--------------------------------------------------------------------------------
SYMPTOMS
1 A sudden, severe headache worse than anything you have ever had in your life. That's a sign that a knock on the head may be more serious than you think, said neurosurgeon Alvin Hong.
2 Loss of consciousness.
3 Weakness or persistent numbness afterwards, or drowsiness.
4 Neck stiffness, which may be due to an aneurysm - a fluid-filled bulge in the wall of an artery - rupturing.
5 Persistent giddiness and vomiting, especially if accompanied by a very severe headache
**************************************************
I never knew Miss Sai Fengmin, but she was a friend of a friend.
Sometimes I really hate the way the media sensationalizes everything with what little knowledge that they have - while revealing the truth, quite by accident.
Sudden, severe (? "thunderclap" ?? )headache - in extremis.
Loss of consciousness.
Giddiness, lethargy.
Nausea and vomiting.
Photophobia.
I really don't think that the family should have been made to feel guilty about omitting to mention the minor head trauma a month ago.
I don't have all the facts here.
But ask any medical student to put the signs together, as written in the newspaper.
Any student.
It's pass-fail viva stuff. And then ask them what must be done next.
And then all sorts of questions begin to spring up, which I shan't alude to. I know what happens to people like me, who even begin to write what I've written.
Troubled
More Troubled
*******
Why write
A few nights back J, the lawyer-babe who mixes a mean cocktail commented that she doesn't write because she prefers to keep everything in her head; words are simply insufficient to capture her thoughts.
And if certain memories hurt you, why write about them at all - why leave a trail behind that might remind you one day?
Does writing give you a catharsis, she asked.
*****
It is important to mourn; important to remember.
Important to write, to cry, to speak and to be heard.
These are the ways we do justice to our memories.
It is right to struggle to remember, againt each passing day as time and life wear us down - it is right, to write, to help us in the future as sensescence claims our memories a day at a time.
*****
Writing doesn't make me feel better. It offers no solace, no shelter. It gives me no catharsis. The things I write about, when they mean anything significant, are the passage of love, of goodness, of happiness, and even of friends.
It just feels right, to write.
*****
I took a photo of myself today. It's a rare day when it happens, I hate being taken, no idea why.
Only today I was in my new uniform (which I still have almost no idea how to put on properly) and it bore a passing resemblance to a policeman's outfit, and I remembered how much the ex likes policemen.
I won't write it; perhaps in the future I won't even remember the thought that just crossed my mind.
Anyway, I remembered another time when I was in uniform, and I thought nothing of snapping my photo and sending it to her.
Today I took the photo on a whim, and strangely looked fairly decent in the first (and only) shot.
And then it took me another few hours, before I sent it.
That's what time does. It makes things... difficult.
Each passing day another cinder falls from the bridges that we have burnt, and one day nothing will remain of our memory, in our memories.
That's just the way it goes.
*****
....et dimitte nobis debita nostra sicut et nos dimittimus debitoribus nostris
And if certain memories hurt you, why write about them at all - why leave a trail behind that might remind you one day?
Does writing give you a catharsis, she asked.
*****
It is important to mourn; important to remember.
Important to write, to cry, to speak and to be heard.
These are the ways we do justice to our memories.
It is right to struggle to remember, againt each passing day as time and life wear us down - it is right, to write, to help us in the future as sensescence claims our memories a day at a time.
*****
Writing doesn't make me feel better. It offers no solace, no shelter. It gives me no catharsis. The things I write about, when they mean anything significant, are the passage of love, of goodness, of happiness, and even of friends.
It just feels right, to write.
*****
I took a photo of myself today. It's a rare day when it happens, I hate being taken, no idea why.
Only today I was in my new uniform (which I still have almost no idea how to put on properly) and it bore a passing resemblance to a policeman's outfit, and I remembered how much the ex likes policemen.
I won't write it; perhaps in the future I won't even remember the thought that just crossed my mind.
Anyway, I remembered another time when I was in uniform, and I thought nothing of snapping my photo and sending it to her.
Today I took the photo on a whim, and strangely looked fairly decent in the first (and only) shot.
And then it took me another few hours, before I sent it.
That's what time does. It makes things... difficult.
Each passing day another cinder falls from the bridges that we have burnt, and one day nothing will remain of our memory, in our memories.
That's just the way it goes.
*****
....et dimitte nobis debita nostra sicut et nos dimittimus debitoribus nostris
Saturday, October 18, 2008
Playing with matches
I was driving her home.
"What kind of girl do you go for?"
"Well..."
Silence for a while. All the people who have come and gone, faces past and present flashed by in my head.
"...I just know it when I see it."
Sometime later.
"If MM wasn't attached I'd've have thought you two would make a pretty good match..."
I raised an eyebrow.
A good match? What's a match but a piece of wood with some sulphur on the end?
What's compatibility, what's suitability - what's anybility got to do with it?
All There is - just a feeling when you meet someone : right or wrong. Something present, versus something absent. Something elusive, something that feels precious - but really isn't.
And in the aftermath, a realization that that feeling has, to put it clinically, no bearing on the long term prognosis of how things will work out.
That feeling is purely subjective. That feeling that this is... something good.Is purely subjective.
And so often wrong.
*****
And so I'm here, trapped in hospital with nothing to drink but yakult.
I want to walk. To run.
To escape.
"What kind of girl do you go for?"
"Well..."
Silence for a while. All the people who have come and gone, faces past and present flashed by in my head.
"...I just know it when I see it."
Sometime later.
"If MM wasn't attached I'd've have thought you two would make a pretty good match..."
I raised an eyebrow.
A good match? What's a match but a piece of wood with some sulphur on the end?
What's compatibility, what's suitability - what's anybility got to do with it?
All There is - just a feeling when you meet someone : right or wrong. Something present, versus something absent. Something elusive, something that feels precious - but really isn't.
And in the aftermath, a realization that that feeling has, to put it clinically, no bearing on the long term prognosis of how things will work out.
That feeling is purely subjective. That feeling that this is... something good.Is purely subjective.
And so often wrong.
*****
And so I'm here, trapped in hospital with nothing to drink but yakult.
I want to walk. To run.
To escape.
Wednesday, October 15, 2008
No means No
The department secretary called up the other day :
Sec : Are you going for the hospital dinner and dance?
Me (irritated, because running busy clinic) : What? No. Thanks.
Sec : Please lah, we need someone to go
Me : No thank you
Sec : So you're going ah
Me : When is it?
Sec : At the end of the month, I'll put you and your partner down
Me : What? I have no partner. And I don't want to pay.
Sec : Its okay its paid for by the department, so you're going ya?
Me : No!
Sec : Too bad (hangs up)
Some time later I get an email from the uber secretary warning people of the consequences of backing out of the "deal", namely that the department will force defaulters to pay for their own tickets.
It gets worse, shortly after I receive an invitation card to the dinner and dance, labelled (Re-mi) and wife.
So now I'm married. I must have been pretty fucking wasted at the time because I sure as hell don't remember the ceremony.
*****
So once upon a time I would have asked the ex to go, and she would have declined because she couldn't have been seen in hospital-public with me, and I would probably have stayed at home moping and studying while my hundred bucks goes to waste while she went out clubbing with her friends. Shrug.
Anybody feel like going to a stupid hospital dinner and dance? I have two spare tickets.
Sec : Are you going for the hospital dinner and dance?
Me (irritated, because running busy clinic) : What? No. Thanks.
Sec : Please lah, we need someone to go
Me : No thank you
Sec : So you're going ah
Me : When is it?
Sec : At the end of the month, I'll put you and your partner down
Me : What? I have no partner. And I don't want to pay.
Sec : Its okay its paid for by the department, so you're going ya?
Me : No!
Sec : Too bad (hangs up)
Some time later I get an email from the uber secretary warning people of the consequences of backing out of the "deal", namely that the department will force defaulters to pay for their own tickets.
It gets worse, shortly after I receive an invitation card to the dinner and dance, labelled (Re-mi) and wife.
So now I'm married. I must have been pretty fucking wasted at the time because I sure as hell don't remember the ceremony.
*****
So once upon a time I would have asked the ex to go, and she would have declined because she couldn't have been seen in hospital-public with me, and I would probably have stayed at home moping and studying while my hundred bucks goes to waste while she went out clubbing with her friends. Shrug.
Anybody feel like going to a stupid hospital dinner and dance? I have two spare tickets.
Fishbowl
It was rather surreal when she called, and just a little unnerving.
It wasn't that it was a surprise call out of the blue, but rather because she sounded exactly like Her.
It would have been less unsettling had it just been that common accent, but it was - the pitch, the turns of phrase, the mannerisms she chose, and that laugh.
The difference though lay in her thoughts, and the way she looked out upon the world.
She said I like that you see the humour in everything...
...and then I couldn't help but remember.
*****
I wrote to Her to stay well clear from this place; the jump from the first world to the third is precipitous and potentially damaging. She writes back that the grass is always greener...
I remember thinking that once - why not give it a shot, how bad can it get, besides the grass is always greener on the other side.
How much younger and more naive I was then, living in the big city of the world.
It wasn't that it was a surprise call out of the blue, but rather because she sounded exactly like Her.
It would have been less unsettling had it just been that common accent, but it was - the pitch, the turns of phrase, the mannerisms she chose, and that laugh.
The difference though lay in her thoughts, and the way she looked out upon the world.
She said I like that you see the humour in everything...
...and then I couldn't help but remember.
*****
I wrote to Her to stay well clear from this place; the jump from the first world to the third is precipitous and potentially damaging. She writes back that the grass is always greener...
I remember thinking that once - why not give it a shot, how bad can it get, besides the grass is always greener on the other side.
How much younger and more naive I was then, living in the big city of the world.
Sunday, October 12, 2008
On mice and men
There's a reason for this.
The same way there's a reason I found myself alone at Klee on Friday just needing a drink, and a laugh. Just to laugh.
There're so many reasons for the world; but none of them are for me.
There's a reason why mice think they rule the country - because by and large they do -- and a reason why I was never truly a mouse - because I don't belong here.
And a reason why I don't play their games : because I never belonged here.
I never saw a world of mice and men. I lived for eight years in a society of people. Just people.
And even before I left, even growing up in the country apart from the system : I just saw people. Just people.
There's a reason why C cheesed off the bartenders at Klee, and the Family of women who had taken me under my wing, and a reason why I didn't. I never walked the walk of a mouse, never wanted to appear overbearing, overconfident or arrogant.
I simply don't think in terms of mice, and men.
I just see people.
******
And maybe a reason why it feels like there's nobody to talk to right now when I really need to, and even if there were I wouldn't want to, and a reason why it's just so damn hard to read and maybe a reason why I don't eat much from time to time, and why tonight I'm hungry but I don't feel like eating.
I'm sure there's a reason for everything.
I'm sure there's a reason for everything.
Malcontent
LL, after reading MM's blog went "Well, what can I say... she's... a malcontent."
Sitting here in my torn jeans and T, somewhere out there in a very generic call room, feeling - something - at the back of my mind, I can't help but feel that LL is dead wrong - that people like MM need to find people who are grounded, like yours truly, to talk to.
Because I remember what I was like before the running started - the same existential fears, the same worries about the world around me, the same frustrations, the same wry throw everything over your shoulder conclusions - i'm no angel, no politician, no - body. Worries for another person and time and universe.
I remember when I was still a kid always badgering my dad with Whys and How Comes till he'd tell me to shut up and eat my vegetables. And even beyond that, till the Mother told me to quit harrassing my dad - but my dad had all the answers, my dad was the Wisest, you see. Good old Dad. If he'd paid me any heed he'd have noticed I pre-empted the flu vax long before it happened - one of the questions was why can't we take viruses and make them inject our own DNA back into our own cells?
So I learnt over time that there were no answers for a lot of the questions I asked - there were plenty of answers for other questions, but they didn't seem worth asking. I don't know what it was that drove me back then, but I just had to keep wondering, and thinking too much. (Was it You that told me once upon a lifetime ago that I think too much? Hmm perhaps it was.)
Why do we hurt each other? Why war? Why genocide? Why hatred? Why military expenditure? Why dictatorship...
Too many questions with no answers.
Gradually you learn to tune out the questions; there's just no point repeating yourself ad infinitum. You get battered by the reality of life; somewhere along the way you mess up and are left with a lifetime of regrets. You become self-centered and with each passing heartache you feel a little less like thinking, and a lot more like running.
And suddenly you're here, trapped.
In a call room with a leash attached to your mobile phone.
In a country with an iron grip around your whole life.
And there's so many places to run, but all the roads lead back here.
You wear black a lot for some undiscernable reason, and the other doctors let slip what they think one day by stating that they guess you went to goth parties a lot overseas. Your mother watches you leave the house and does a double take that you're going to work in... those ripped jeans?
Pause, and rewind. My god. This is me.
Closet rebel. (pun intended)
Bein worn down by the system.
Cookie cutter cutout citizen.
Dreaming of a better future, somewhere else.
I remember You asking a few years back - what happened to us, the best and the brightest?
People tell me that it's no better elsewhere, all systems are flawed. People are racist out there. You'll never belong.
I remember Su. and B. And all the other people of significance I once knew. How many of you are left here?
How many of you were willing to choose building a protective little bubble around your life to block out the world around you to living somewhere where you didn't need the bubble at all in the first place - and could just get on with the living.
It's true. I'll never belong out there.
But I don't belong here, either. Not in the land of the blue pill. Not somewhere safe where everything's fine because there's no crime, no deviancy, no poverty, no "badness".
I've said it countless times.
A society needs all these things to function properly. People need these things to remember to fear, and remember when not to; to remember when to laugh, and to remember when to look twice. To stop feeling superior over things that don't matter and patting themselves on the back over things that are so, so very trivial (a hub! a hub! my kingdom for a hub!) and to start feeling worried about the things that really do.
A country needs helmsmen who know right from wrong and good from bad.
I need somewhere where I can remember who I am, and where moral ambiguity isn't a daily routine, but something I can keep at bay; something tangible and dangerous that I can choose to shy away from.
I'm not. Grounded.
I don't know if I'm malcontent, age has changed a lot in me.
But I know that I am not content.
I want to be - of course I do. Who doesn't?
Not so very long ago I had my own little bubble, and a year and a bit just flew by so very quickly. I had a vague dream that I could cling to, a small shelter from the reality of the world around me. And then the walls came down, and I was clingy. Who wouldn't be? I didn't choose the red pill, it was forced upon me.
And then there were questions again, questions that I had escaped since the last time around - a year before. Questions I had escaped since my teenage years.
Why do people hurt each other?
What's the point in trusting people - everyone's in it for their own self gain. Everybody has an agenda.
You can offer your trust to someone, and make him or her aware that you know that you're exposing yourself to his or her mercy - armed with the knowledge of your insight -- they still abuse that trust, perhaps with a cleaner conscience.
Then wherefore trust?
I'm old enough to know the answers - there are no answers, and its not my pasa. I'm also old enough to know that sometimes you just have to.
And sometimes you don't.
*****
It happened again; I've been around for so long I've seen two cycles now.
The hospital, let's call it Old Chang Kee to humour the ex, I promised her I'd write like this someday... was embroiled in a mass casualty.
"Simulated" patients came boiling into the hospital, and doctors were activated by the hundreds to show the world how capable we are of handling a disaster.
And in the aftershock... I mean aftermath, I'm sure some minister will receive a glowing report about how well we did, and how much we learnt.
And I, caught in the thick of it, couldn't help but remember another time and place, and think as I watched the system start to buckle - fucking amateurs.
It shouldn't be this way; not after so many trial runs in the past. The system has no forethought, no redundancy. The loopholes have not been closed, the lessons from the past are still unlearnt. Next cycle will see a new brainchild fall on its face, and bring a new batch of glowing reports.
If you want to plug the gaps, then fucking run the scenario countless times over till you've spotted them all.
You don't need a huge one day drag-on-forever affair to prove a point. You don't need your simulated patients being run around the hospital by exhausted anaesthetists to prove that the system works, when it really doesn't.
Back in the day, somewhere in the UK we just sat down to a lot of sheets of paper. We had an objective in mind - to find the loopholes. All of us, from the lowly SHOs to the senior consultants. We had a disaster scenario clearly painted out to us (not wondering halfway in what kind of disaster just happened anyway? What's going on??) and not just to some invisible senior staff far removed from the real world in their command posts.
The times were made up. The delays were calculated based on real-life analysis.
The chokepoints became obvious. Brainstorming was done and comments welcome from the ground up.
Not this sham we pulled which culminated in us milling around bemused, waiting to ferry our triple-stacked patients up to the wards from the filled beyond capacity emergency department.
Technology speeds up simulations. Why can't we fucking learn from the rest of the world? Just have an electronic exercise. Plug in the variables. Create plans. Create contingency plans. Test them on the simulation. Perfect your game.
And then when you think you have it sorted, hold your grand full-fledged exercise. And audit audit audit. The times, the chokepoints... and the clinical care. Shouldn't a disaster scenario be about checking standards of care provision as well? Isn't that the crux of healthcare - not just number crunching?
On number crunching - how the fuck can you run a mass casualty exercise without going into army triage mode? What kind of moron imagines they can save the world when the twin towers come crumbling down?
*****
That's what troubles me, all too often, about living out here.
We're a first world country with a third world mindset. We don't look forwards. We don't think.
We do what we're told. We run. We hide.
We leave it to someone else, who has the brains, the power, the authority.
We are nothing, and our views are for naught.
And one day when the men in white find this, we are someone to squash, and to silence, with another nice presidential tea or lunch.
*****
I read her entry about CERN and remembered a time when I would have wondered the same.
I recall telling a friend wryly once the nature of reality and Schrodinger's cat in the box. And how reality doesn't have to tie up the way we know it, as mere... specks on the face of this universe, coming to grips with our own reality through the magic of science.
Just because this looks like a light switch doesnt mean that when I flip it a rack of nuclear missiles won't rain down on Iran, triggering the end of the world...
We know it's not true within a certain confidence interval, but we'll never know for sure.
Who's to say what happens when you break reality up into its smallest fragments? The think tanks postulate Higgs Bosun; I'm sure trekkies and sci fi addicts would love for a rip in the space time continuum to materialize.
I'm sure life will just go on, and tomorrow we'll land on mars and we won't even bat an eyelid.
A century from now we'll probably still be screwing each other over in life, love and international relations, just the way we always have.
But it's an interesting thought nonetheless. Maybe it'd actually be a good thing if something unthinkable happens. Maybe if Stephen King comes real, instead of Arthur C Clarke, we'll actually learn something from the madness we call our humanity, for once.
Sitting here in my torn jeans and T, somewhere out there in a very generic call room, feeling - something - at the back of my mind, I can't help but feel that LL is dead wrong - that people like MM need to find people who are grounded, like yours truly, to talk to.
Because I remember what I was like before the running started - the same existential fears, the same worries about the world around me, the same frustrations, the same wry throw everything over your shoulder conclusions - i'm no angel, no politician, no - body. Worries for another person and time and universe.
I remember when I was still a kid always badgering my dad with Whys and How Comes till he'd tell me to shut up and eat my vegetables. And even beyond that, till the Mother told me to quit harrassing my dad - but my dad had all the answers, my dad was the Wisest, you see. Good old Dad. If he'd paid me any heed he'd have noticed I pre-empted the flu vax long before it happened - one of the questions was why can't we take viruses and make them inject our own DNA back into our own cells?
So I learnt over time that there were no answers for a lot of the questions I asked - there were plenty of answers for other questions, but they didn't seem worth asking. I don't know what it was that drove me back then, but I just had to keep wondering, and thinking too much. (Was it You that told me once upon a lifetime ago that I think too much? Hmm perhaps it was.)
Why do we hurt each other? Why war? Why genocide? Why hatred? Why military expenditure? Why dictatorship...
Too many questions with no answers.
Gradually you learn to tune out the questions; there's just no point repeating yourself ad infinitum. You get battered by the reality of life; somewhere along the way you mess up and are left with a lifetime of regrets. You become self-centered and with each passing heartache you feel a little less like thinking, and a lot more like running.
And suddenly you're here, trapped.
In a call room with a leash attached to your mobile phone.
In a country with an iron grip around your whole life.
And there's so many places to run, but all the roads lead back here.
You wear black a lot for some undiscernable reason, and the other doctors let slip what they think one day by stating that they guess you went to goth parties a lot overseas. Your mother watches you leave the house and does a double take that you're going to work in... those ripped jeans?
Pause, and rewind. My god. This is me.
Closet rebel. (pun intended)
Bein worn down by the system.
Cookie cutter cutout citizen.
Dreaming of a better future, somewhere else.
I remember You asking a few years back - what happened to us, the best and the brightest?
People tell me that it's no better elsewhere, all systems are flawed. People are racist out there. You'll never belong.
I remember Su. and B. And all the other people of significance I once knew. How many of you are left here?
How many of you were willing to choose building a protective little bubble around your life to block out the world around you to living somewhere where you didn't need the bubble at all in the first place - and could just get on with the living.
It's true. I'll never belong out there.
But I don't belong here, either. Not in the land of the blue pill. Not somewhere safe where everything's fine because there's no crime, no deviancy, no poverty, no "badness".
I've said it countless times.
A society needs all these things to function properly. People need these things to remember to fear, and remember when not to; to remember when to laugh, and to remember when to look twice. To stop feeling superior over things that don't matter and patting themselves on the back over things that are so, so very trivial (a hub! a hub! my kingdom for a hub!) and to start feeling worried about the things that really do.
A country needs helmsmen who know right from wrong and good from bad.
I need somewhere where I can remember who I am, and where moral ambiguity isn't a daily routine, but something I can keep at bay; something tangible and dangerous that I can choose to shy away from.
I'm not. Grounded.
I don't know if I'm malcontent, age has changed a lot in me.
But I know that I am not content.
I want to be - of course I do. Who doesn't?
Not so very long ago I had my own little bubble, and a year and a bit just flew by so very quickly. I had a vague dream that I could cling to, a small shelter from the reality of the world around me. And then the walls came down, and I was clingy. Who wouldn't be? I didn't choose the red pill, it was forced upon me.
And then there were questions again, questions that I had escaped since the last time around - a year before. Questions I had escaped since my teenage years.
Why do people hurt each other?
What's the point in trusting people - everyone's in it for their own self gain. Everybody has an agenda.
You can offer your trust to someone, and make him or her aware that you know that you're exposing yourself to his or her mercy - armed with the knowledge of your insight -- they still abuse that trust, perhaps with a cleaner conscience.
Then wherefore trust?
I'm old enough to know the answers - there are no answers, and its not my pasa. I'm also old enough to know that sometimes you just have to.
And sometimes you don't.
*****
It happened again; I've been around for so long I've seen two cycles now.
The hospital, let's call it Old Chang Kee to humour the ex, I promised her I'd write like this someday... was embroiled in a mass casualty.
"Simulated" patients came boiling into the hospital, and doctors were activated by the hundreds to show the world how capable we are of handling a disaster.
And in the aftershock... I mean aftermath, I'm sure some minister will receive a glowing report about how well we did, and how much we learnt.
And I, caught in the thick of it, couldn't help but remember another time and place, and think as I watched the system start to buckle - fucking amateurs.
It shouldn't be this way; not after so many trial runs in the past. The system has no forethought, no redundancy. The loopholes have not been closed, the lessons from the past are still unlearnt. Next cycle will see a new brainchild fall on its face, and bring a new batch of glowing reports.
If you want to plug the gaps, then fucking run the scenario countless times over till you've spotted them all.
You don't need a huge one day drag-on-forever affair to prove a point. You don't need your simulated patients being run around the hospital by exhausted anaesthetists to prove that the system works, when it really doesn't.
Back in the day, somewhere in the UK we just sat down to a lot of sheets of paper. We had an objective in mind - to find the loopholes. All of us, from the lowly SHOs to the senior consultants. We had a disaster scenario clearly painted out to us (not wondering halfway in what kind of disaster just happened anyway? What's going on??) and not just to some invisible senior staff far removed from the real world in their command posts.
The times were made up. The delays were calculated based on real-life analysis.
The chokepoints became obvious. Brainstorming was done and comments welcome from the ground up.
Not this sham we pulled which culminated in us milling around bemused, waiting to ferry our triple-stacked patients up to the wards from the filled beyond capacity emergency department.
Technology speeds up simulations. Why can't we fucking learn from the rest of the world? Just have an electronic exercise. Plug in the variables. Create plans. Create contingency plans. Test them on the simulation. Perfect your game.
And then when you think you have it sorted, hold your grand full-fledged exercise. And audit audit audit. The times, the chokepoints... and the clinical care. Shouldn't a disaster scenario be about checking standards of care provision as well? Isn't that the crux of healthcare - not just number crunching?
On number crunching - how the fuck can you run a mass casualty exercise without going into army triage mode? What kind of moron imagines they can save the world when the twin towers come crumbling down?
*****
That's what troubles me, all too often, about living out here.
We're a first world country with a third world mindset. We don't look forwards. We don't think.
We do what we're told. We run. We hide.
We leave it to someone else, who has the brains, the power, the authority.
We are nothing, and our views are for naught.
And one day when the men in white find this, we are someone to squash, and to silence, with another nice presidential tea or lunch.
*****
I read her entry about CERN and remembered a time when I would have wondered the same.
I recall telling a friend wryly once the nature of reality and Schrodinger's cat in the box. And how reality doesn't have to tie up the way we know it, as mere... specks on the face of this universe, coming to grips with our own reality through the magic of science.
Just because this looks like a light switch doesnt mean that when I flip it a rack of nuclear missiles won't rain down on Iran, triggering the end of the world...
We know it's not true within a certain confidence interval, but we'll never know for sure.
Who's to say what happens when you break reality up into its smallest fragments? The think tanks postulate Higgs Bosun; I'm sure trekkies and sci fi addicts would love for a rip in the space time continuum to materialize.
I'm sure life will just go on, and tomorrow we'll land on mars and we won't even bat an eyelid.
A century from now we'll probably still be screwing each other over in life, love and international relations, just the way we always have.
But it's an interesting thought nonetheless. Maybe it'd actually be a good thing if something unthinkable happens. Maybe if Stephen King comes real, instead of Arthur C Clarke, we'll actually learn something from the madness we call our humanity, for once.
Wednesday, October 8, 2008
Why
Why do you need to take your exam from here, she asked.
Why, because...
because...
And then I realised. I don't. I really don't have to.
Why, because...
because...
And then I realised. I don't. I really don't have to.
Sunday, October 5, 2008
Crazy Eyes
I spent last night playing with Xena's two Jack Russels.
The boy dog, Elmo has absolutely insane eyes. Slightly googly like a pug's, but not in the least bit benign.
I first made the acquaintence of Elmo when I was repairing Xena's then-computer.
Xena fell asleep hugging her two babies, and once she was out, Elmo squirmed out from under her arm and slunk to the edge of the bed, where I could sense him staring at me out the corner of my eye, and feel his doggy breath on my ear.
It was because I refused to make eye contact and ignored him that he didn't bite me, and also the reason why he has never attempted to take a chunk out of me yet, to date anyway.
I kinda like him. He has crazy eyes.
*****
Spent this evening playing the piano for a bit with my mum. It's been a while - the ex wrote about how beautiful it was to watch.
The boy dog, Elmo has absolutely insane eyes. Slightly googly like a pug's, but not in the least bit benign.
I first made the acquaintence of Elmo when I was repairing Xena's then-computer.
Xena fell asleep hugging her two babies, and once she was out, Elmo squirmed out from under her arm and slunk to the edge of the bed, where I could sense him staring at me out the corner of my eye, and feel his doggy breath on my ear.
It was because I refused to make eye contact and ignored him that he didn't bite me, and also the reason why he has never attempted to take a chunk out of me yet, to date anyway.
I kinda like him. He has crazy eyes.
*****
Spent this evening playing the piano for a bit with my mum. It's been a while - the ex wrote about how beautiful it was to watch.
Hope-less
Today saw us running for Hope today, untrained muscles protesting against a shock decision to enter us in a ten kilometer run (at least it wasn't an army half) as we struggled not-so-valiantly on. There was talk half way of abandoning our run and pigging out at mcdonald's, but the ever present fear of the apparition of the boss solidifying before our eyes kept us plodding steadily onwards.
After the run we finally had that promised mcdonald's brekky. I was disturbed to watch full grown men fretting about their caloric intakes, but such is the way of the world these days, when women are women, and men are women too.
*****
I remember those last moments when we parted.
You were curled up in bed gasping for breath. Your eyes were filled with pain and anguish, as were mine.
The boy who talked too much for you stood mutely over you, all out of words.
I want you to know that all I felt was overwhelming pain and sadness.
There was no anger, no hatred.
Perhaps in some alternate universe out there we found the courage to speak to each other and make nice again.
In this one I turned, and left, before my world broke any further apart.
I never wanted us to end this way. Not like this.
*****
I listened to J telling me about her breakup.
I can't believe he's dating again! I can't fucking believe he's dating again! It's only been a week!
And then I remembered what you wrote :
Ten days.
*****
I remember how whenever I heard distressing things like the other doctors boasting about shagging the nurses - and you put your cock in her mouth on the sofa... and you did her on the table doggy style... and in the club you... etc
I remember when they were slagging off... your colleagues
I remember feeling the world becoming darker, and being thankful that I had you, that I had a place to take refuge from the darkness and insanity of the world around me; I remember how I used to tell you all about it, and how you would console me and things seemed better again.
I remember how everything felt the instant the darkness of the world suddenly seemed to have seeped into my last place of shelter.
*****
Did it ever strike you how ironic things are?
How E used to try to persuade you that I would be like all the other doctors - a cheat, a liar. How you wrote that you defended me to her, but secretly worried it might be true - because you could understand how it happens all too easily, someone more beautiful, someone fresher faced.
And how at the end of the day it was E herself that was the liar and the cheat.
That E and C are still working through their differences, manipulative and malignant as they are, and that we have lost everything between us, although we were... not like them?
How you wrote how much you had to lose us for your peace of mind - so that you wouldn't be tormented.
And how you were tormented when we lost each other? As was I?
I know how these things work. Each passing day our bridges remain burnt makes the crossing more difficult; each passing day brings new people into our lives, and makes our memory dwindle.
It struck me how odd everything was the other day, as I was talking to G online.
G! Who out and out betrayed me - friends again (although obviously no longer as close as before, and perhaps friends only in name)
We - two people who were - I like to think - good kids. Good to each other. All you have to say to me is fuck off, and all I can do is not think about things.
After the run we finally had that promised mcdonald's brekky. I was disturbed to watch full grown men fretting about their caloric intakes, but such is the way of the world these days, when women are women, and men are women too.
*****
I remember those last moments when we parted.
You were curled up in bed gasping for breath. Your eyes were filled with pain and anguish, as were mine.
The boy who talked too much for you stood mutely over you, all out of words.
I want you to know that all I felt was overwhelming pain and sadness.
There was no anger, no hatred.
Perhaps in some alternate universe out there we found the courage to speak to each other and make nice again.
In this one I turned, and left, before my world broke any further apart.
I never wanted us to end this way. Not like this.
*****
I listened to J telling me about her breakup.
I can't believe he's dating again! I can't fucking believe he's dating again! It's only been a week!
And then I remembered what you wrote :
Ten days.
*****
I remember how whenever I heard distressing things like the other doctors boasting about shagging the nurses - and you put your cock in her mouth on the sofa... and you did her on the table doggy style... and in the club you... etc
I remember when they were slagging off... your colleagues
I remember feeling the world becoming darker, and being thankful that I had you, that I had a place to take refuge from the darkness and insanity of the world around me; I remember how I used to tell you all about it, and how you would console me and things seemed better again.
I remember how everything felt the instant the darkness of the world suddenly seemed to have seeped into my last place of shelter.
*****
Did it ever strike you how ironic things are?
How E used to try to persuade you that I would be like all the other doctors - a cheat, a liar. How you wrote that you defended me to her, but secretly worried it might be true - because you could understand how it happens all too easily, someone more beautiful, someone fresher faced.
And how at the end of the day it was E herself that was the liar and the cheat.
That E and C are still working through their differences, manipulative and malignant as they are, and that we have lost everything between us, although we were... not like them?
How you wrote how much you had to lose us for your peace of mind - so that you wouldn't be tormented.
And how you were tormented when we lost each other? As was I?
I know how these things work. Each passing day our bridges remain burnt makes the crossing more difficult; each passing day brings new people into our lives, and makes our memory dwindle.
It struck me how odd everything was the other day, as I was talking to G online.
G! Who out and out betrayed me - friends again (although obviously no longer as close as before, and perhaps friends only in name)
We - two people who were - I like to think - good kids. Good to each other. All you have to say to me is fuck off, and all I can do is not think about things.
Saturday, October 4, 2008
Stargazer
D's telling me how bad she feels about her recent breakup.
D is one of the few air stewardesses who rebelled and left the service when she found herself growing into the routine and her brain atrophying from lack of use - and didn't like it.
So, she says, looking at me with those huge, hyponotic liquid lemur eyes of hers - he's the kind of guy who stays home a lot moping by his lonesome.
He's all torn up about the breakup while she's doing okay, going out every night and generally having a great time, and it makes her feel guilty, you see.
I watch her and nod sympathetically, and think : is it really any better? Going out loads with new people I barely know? Is it any better if neither of us is acting terminally-wounded bleeding-heart soldier, but if there's a common spring of sadness oozing steadily away somewhere beneath the mutually happyish veneers?
D goes on to say that she's still friends with most of her exs. I shake my head as I walk, saying I just can't understand how she does it, I've tried just the once and it wasn't good.
*****
We were at your place, which oddly looked exactly like my room.
We were rather stilted and awkward at first, but you started telling me something scandelous about your friends, and as I prompted you for more details you became more and more excited,and were in full swing when there was a knock - just once - on the open door, and then someone strode in stage left. Through that door which opens inwards, which looks exactly like my bedroom door.
He was tall with very short cropped hair, and his body language and puzzlement at finding me here in your room which looked exactly like my room made it very obvious who he was. I remember feeling startled as well, since you hadn't told me you were already going out with someone new.
And then I woke up.
*****
That's Aldebaron, he said, his voice passionate with interest, with just a hint of a smirk on it (I actually glanced sideways as he said it to check, but no, his face was blank)
And then MM said exactly what I was thinking - the way she always seems to - "Whoa! That was kind of sexy!" and glanced at me.
And then we laughed, and I confessed to thinking most un-manly thoughts.
He said well yeah, I tried it on MM but it just didn't work... and MM said quietly, it did at the time, for a moment.
K the bar owner doesn't quite understand; introducing his slew of sexy-bevy beauties to me - that I don't gun for cool impassive obvious ephemeral beauty, but rather for quirky, slightly unstable funny types who're easy to speak to.
I used to imagine it was because said types were good communicators, but watching MM I realise it's because I'm like that myself - MM put her finger on it, remarking that I get on so well with her nutty friends who have taken so quickly to me, which by extrapolation of logic makes me a nutty type myself.
That's precisely it : I understand her; there's just no effort required to follow her train of thought.
Birds of a feather, nuts of a shell.
D is one of the few air stewardesses who rebelled and left the service when she found herself growing into the routine and her brain atrophying from lack of use - and didn't like it.
So, she says, looking at me with those huge, hyponotic liquid lemur eyes of hers - he's the kind of guy who stays home a lot moping by his lonesome.
He's all torn up about the breakup while she's doing okay, going out every night and generally having a great time, and it makes her feel guilty, you see.
I watch her and nod sympathetically, and think : is it really any better? Going out loads with new people I barely know? Is it any better if neither of us is acting terminally-wounded bleeding-heart soldier, but if there's a common spring of sadness oozing steadily away somewhere beneath the mutually happyish veneers?
D goes on to say that she's still friends with most of her exs. I shake my head as I walk, saying I just can't understand how she does it, I've tried just the once and it wasn't good.
*****
We were at your place, which oddly looked exactly like my room.
We were rather stilted and awkward at first, but you started telling me something scandelous about your friends, and as I prompted you for more details you became more and more excited,and were in full swing when there was a knock - just once - on the open door, and then someone strode in stage left. Through that door which opens inwards, which looks exactly like my bedroom door.
He was tall with very short cropped hair, and his body language and puzzlement at finding me here in your room which looked exactly like my room made it very obvious who he was. I remember feeling startled as well, since you hadn't told me you were already going out with someone new.
And then I woke up.
*****
That's Aldebaron, he said, his voice passionate with interest, with just a hint of a smirk on it (I actually glanced sideways as he said it to check, but no, his face was blank)
And then MM said exactly what I was thinking - the way she always seems to - "Whoa! That was kind of sexy!" and glanced at me.
And then we laughed, and I confessed to thinking most un-manly thoughts.
He said well yeah, I tried it on MM but it just didn't work... and MM said quietly, it did at the time, for a moment.
K the bar owner doesn't quite understand; introducing his slew of sexy-bevy beauties to me - that I don't gun for cool impassive obvious ephemeral beauty, but rather for quirky, slightly unstable funny types who're easy to speak to.
I used to imagine it was because said types were good communicators, but watching MM I realise it's because I'm like that myself - MM put her finger on it, remarking that I get on so well with her nutty friends who have taken so quickly to me, which by extrapolation of logic makes me a nutty type myself.
That's precisely it : I understand her; there's just no effort required to follow her train of thought.
Birds of a feather, nuts of a shell.
Friday, October 3, 2008
Stay awake
Driving home after a particularly long and sleepless public-holiday call, I had a bad "moment". Don't know what the precipitant was, all I was trying to do was stay awake.
There wasn't any associated visual or audio flashback, just a sudden moment of... crushing sadness.
Catharsis :
Who moves on first, who forgets who first and finds happiness first... it's all moot; that's what happens when two lives diverge, right?
S, J's friend is wrong, as is J. It's not about "winning" at all... it's not really a game is it?
There were no winners between us; just two losers left to pick up the pieces on their own, left with their memories of a love that had once felt real.
I went for a haircut and remembered the last time I'd been there, remembered messaging her from time to time while my hair was being washed, then cut, then dried. Remembered meeting her afterwards when I was done.
And then I closed my aching eyes, while the lady was asking me if the water temperature was all right, and just thought : I so need a laugh.
I so need to laugh.
And then my phone rang - and it was MM.
"hello...?"
And then we laughed.
There wasn't any associated visual or audio flashback, just a sudden moment of... crushing sadness.
Catharsis :
Who moves on first, who forgets who first and finds happiness first... it's all moot; that's what happens when two lives diverge, right?
S, J's friend is wrong, as is J. It's not about "winning" at all... it's not really a game is it?
There were no winners between us; just two losers left to pick up the pieces on their own, left with their memories of a love that had once felt real.
I went for a haircut and remembered the last time I'd been there, remembered messaging her from time to time while my hair was being washed, then cut, then dried. Remembered meeting her afterwards when I was done.
And then I closed my aching eyes, while the lady was asking me if the water temperature was all right, and just thought : I so need a laugh.
I so need to laugh.
And then my phone rang - and it was MM.
"hello...?"
And then we laughed.
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