Archive for September, 2006

Waterfront living

Where I live is kind of cool. Like a yuppy apartment complex. Though that’s hardly being positive. It’s in a place called Ahuiri, which is part of Napier, which is on the east coast of NZ, which is a country east of Australia. In fact, simplest way to describe it is dig straight down and you’ll get here. Eventually.

Napier has a port, a proper port, with a big fence round it and container ships and unruly sea men and big cranes operated by unruly sea men to load and unload the container ships. I drive past it every day to work and I think about the three quid kettle I bought and how it started in China and there’s probably a container full of kettles somewhere in the middle of that pile of containers stacked 15 high by 15 wide. International logistics and transport fascinated me.

Anyhow, Ahuiri is at the port and it used to be a bit of a dump. Most port towns are. Just picture Larne, Stranraer and Holyhead. Evil, nasty places. Possibly worse than Lurgan. You used to be able to buy houses for nothing here, no one wanted to live here.

But a few creative entrepreneurs opened a few nice bars, and they put in a marina where you could put your fancy boat and all of a sudden everyone wants to live here. ‘Waterfront living’ is a popular term.

My block of apartments is beside a rail line and a stack of empty warehouses, but remarkably it’s actually a nice area. There’s four blocks and only two are even half-finished. I think I may have been the first person to move in to my block of 40. I was living in a caravan so I was kind of desperate. The place didn’t have any blinds and all the kitchen appliances still needed plugged in.

It’s quite fancy, well by my standards, which are pretty low to be honest… It’s got lots of shiny chrome bits and heavy wooden furniture and leather sofas that recline. It’s like sneaking into business class on the plane, you’re just waiting for someone to find you out and stick you at the back of the bus.

It has a waste disposal unit thingy. And these have always fascinated me. It’s like a food mixer that lives in your plug hole. You put anything down it and press the switch and it smashes it to a pulp and sends it down the pipe. The fridge beeps at you when you leave the door open. It has an air-con unit in the ceiling, which I have no idea how to work.

To top it all it has a pool and gym on site which is free to use. Well it would be if it was open yet but as I say this place is all kind of new. I may venture to the pool but I think I’ll give the gym a miss. All that lycra and all those mirrors petrify me. No matter where you look you’re still gonna end up looking at some girls bum in the mirror, and then they’ll get all offended and storm off. Which is ridiculous cause if you’re gonna go to the gym with lots of mirrors and wear all that lycra, then you’ve no excuse. This has of course never happened to me but I can imagine.

Probably safer to stick to the pool. As long as they don’t come up with some stupid speedo and swim cap rule anyway. And it’s not full of kiddies with lax bladder control… I need the loo.

Fix

So often I have this suffocating sensation that I’m running out of time, that there’s not enough time to get it all done. That every second of my life that I’ve not filled with activity or strictly defined purpose, is a waste and a rule broken (see two blogs back). This cripples me, leaves me busy, frustrated alone and self-absorbed. But that’s a book in itself…

And as I get settled (I’ll be saying that till I leave), I find it happening here. That when I get to know people here I’m not having time to write and think and procrastinate. The important things clearly. And so I got a back log of blogs and I’ve had to start making a list (I like lists)  on my phone so that I wouldn’t forget the topics. So this is a coffee related blog.

People in Hawke’s bay are big into coffee. There’s a café culture that you meet up with your mate and have coffee at a pavement café. And they do it well. None of your Nescafe muck now, nothing but the best. The church I go to was set up by a guy who used to run a café so there’s none of your industrial size tub of Maxwell house instant prepared by a lovely be-hatted (?!) church member. It’s a full on espresso machine as big as a bath tub at the back.

Doctors, and to be fair, hospital staff in general have an addiction to caffeine. It wouldn’t be the NHS if there weren’t tea breaks. Only a shadow of the civil service I’m told (eh gaz?) Hawke’s bay hospital has it’s own espresso stand in the main corridor just down from A&E. Entitled Fix. Winner.

Now this has required a whole new language for me. I’m used to just asking for black coffee. But there’s no such thing. I can have a short black or a long black, neither of which seem to affect the size of the cup. My new tipple is a flat white, a kind of cappuccino style thing (all coffees with milky stuff in it are cappuccinos to me). I had the first drank in seconds. Where had this place been all my life.

The guy who runs it knows what he’s doing and then some. It’s a testament to our addiction that he has enough work to keep him for a 9 hour day. With each coffee you get a sweet (of jelly baby proportions) but everyone knows that Thursday is chocolate fish day (for those concerned that does not mean fish covered in chocolate). He even lets you read his paper on a bar stool at the stand while you get your coffee made. I’ve even joined his loyalty card scheme. You pay for 5 and get a sixth free.

I am aware of the CE café in its embryonic form, so I suggest you take hints.

I’m now left with a dilemma. He has an extensive menu of speciality type coffees with –atto at the end of their names. I want to try them all, but like most things I get comfortable with what I’m used to. I’m afraid I’ll ask for a macchiato (was that not a motorbike…) and he’ll ask me how I want it done and I’ll not know what to say, and I’ll say something like medium-rare and then people will laugh at me and report me to the authorities and I’ll be stripped of my residency, possessions and clothing and set adrift to Vanuatu on a raft made from balsa wood. I do over think things.

Bread and butter

Today was a funny day in work. Maria and Otto (my hungarian bosses) were both off. They actually had to be forced to take a day off cause they’re kind of workaholics. Maria even rang in at one thirty in the morning to make sure a patient got a certain drug.

I work in an AAU (acute admissions unit) where we see folks who usually need a few investigations and chucked out the next day. An attempt to cut prolonged admissions to hospital. It’s a decent place to work. Fewer old demented crocks than usual.

So today the AAU was me and Bob (the ED/A&E boss). Bob spent most of the time running the ED so I was kind of my on my own. And i’ve been kind of baby sat since I started. I think maria and otto have me sussed as a bit of a muppet doc and are trying to stop me killing people. They’re probably right.

Today there was no such baby sitting so I kind of had free reign with the patients. Which is more what i’m used to. First guy. Mr A. He’s fat, a smoker, a diabetic, knackered kidneys, dodgy ticker and low on blood. His lungs are knackered from smoking. This is your standard medical patient. This is my bread and butter.

Except Mr A has a 10p piece on his chest x-ray. And I don’t mean he choked on it. It’s what’s described as a ‘coin lesion’. Lesion is a word doctors use to disguise cancer when we’re talking about it. Everyone knows what tumor and malignancy means these days so we use ‘lesion’ or ‘neoplasm’ to hide it from people.

Mr A doesn’t know this yet. I know this. I know it’s not definite, few things are in medicine but i’ve seen enough to know i’m not wrong. He’s a dead man. So he gets a scan of his chest and it shows he’s got one lesion on the periphery of his lung that’s spread from another one near his wind pipes. I know this. He doesn’t yet. This means he’ll be a dead man in a few months and there’s little anyone can offer him.

Mr A is fed up with hospital. He’s had his blood transfusion and Hawke’s bay are playing rugby tonight and he has work to do in the garden. He has no intention of staying. Mr A can’t complete a sentence without stopping for breath. He’s going no where.

He has to know some time. And Bob (the boss) has gone to a funeral and there’s just me. If it were me i’d want to know. So I go in and I sit down and explain that we saw a ‘shadow’ on his lung and we did a scan to check it out and that we think he has cancer. And that last word sticks in my throat. Like my voice has never said it before. Like it’s not quite sure it should be forming the sounds. The atmosphere changes. We make eye contact. And it’s not like there wasn’t eye contact before but it’s clear now he’s really listening.

He rolls his eyes and sighs. Then mutters an angry comment about how long he’ll have to stay in hospital then he looks at me again and he’s petrified. Anger, denial, acceptance and fear in seconds.

He asks me to ring his daughter and tell her to come over. I ring her. I fear she’ll ask me why I rang her. But she spares me that.

I have this fear of unexpected phone calls form unknown numbers from people I don’t know at odd times. I’m convinced the worst has happened. My heart thumps till the person on the other end of the line explains why they’re ringing.

So his daughters turn up, and his wife. And I tell them and him the same thing as before. I use the word cancer again. And still it sticks in my throat. If I didn’t say it then they wouldn’t get it. Until you mention the word everything you say to them will be meaningless. His wife cries, he cries. He thanks me. He thanks me. He thanks me for telling him he has cancer. My eyes fill with tears and I make myself look in his eyes and I make myself hold his hand cause he deserves it and so much more.

There are a lot of rules

Rules. We all follow them. Even those who say they don’t. The sub-groups and the trends and the stylish rebellious people of the world are the most conformist I know. (not that I know many of them, I never seem to get invited to the right parties…) Even if non-confomity is what they conform too.

There is possibly nothing less rebellious than being a goth or a 14 year old smoking. They only do it cause their friends do it. No one really wants to be different, they just need to have a group of a certain size where there’s others the same.

I’ve heard it said that everyone does what makes them happy. Even the man who comits suicide. The most altruistic, philanthropic act you can do is still motivated by a desire to be happy. Whether it’s the simple joy of doing the right thing or the joy of having someone see you doing the right thing. Morally there’s a difference in the two joys but that’s a whole nother story.

But in the same respect we all have rules that we follow. It’s part of our personality. Some will be dependable by one set of rules, others will be easy going. Some will be annoying to be with because of them and others will be a pleasure. We all have rules and we all conform to them because that is the only way we have peace and contentment and joy.

I have lots of rules. Many are basic moral codes, pretty much anyone will follow, many are moral things that I do only because of Christianity. And there are many I only do because I believe them to be important.

There’s lots of reasons I choose which rules to follow and which rules not to. I think about those reasons and analyse them and feel bad about them, then good about them, then bad about feeling good about feeling bad about them. This is the essence of my life.

Occasionaly this is therapeutic and beneficial and GOD honouring and occasionally it’s just neurotic and damaging and outright sinful.

And so in the beneficial/therapeutic sense here’s a taster. (and when I say therpeutic/beneficial I mean solely for myself, I am under no illusions).

1) thou shalt not be late.
Where I got this from i’m not sure. Perhaps from being in church twenty minutes before it started for most of my life. This gets to the point that I get nervous and anxious when i’m waiting to go somwhere or do something, or worse when i’m waiting for soemone to pick me up. Cause then it’s out of my control, and i’m never good with that. This flows partly from rule number 2.

2) if you say you’re gonna do something then you do it.
Strong believer in this one. I marvel at people who can talk about going somewhere or doing something and then change their minds shortly before if something else comes up. (i mean this in no critical way, the situations are mostly benign, frivolous things and no one, bar me gets excited if someone pulls out or doesn’t show. And the thing itself in most cases will be in no way affected by their absence. Yet I worry all the same.) I can’t mamage to do this. I view all plans and requests as concrete and set in stone once the initial agreement is made. Naturally there are good sides to this but there are many downsides. If someone, say, organises a kick about for a certain time and I agree, and then someone asks me to do something more useful, beneficial and simply more fun (yes it’s hard to imagine what could be more useful, beneficial and fun than footy but work with me here), then I will be simply unable to miss the footy for the other opportunity. I will simply fret and agonise over the silly rules that I follow.

3) that I will only be weak and wrong in the past tense. And I must insert that there is a world of moral difference between being weak and being wrong. As a freudian slip I put the two beside each other in the first sentence of this paragraph and perhaps that says more about me than anything else. Anyhow. When I talk about weaknesses and struggles I will never talk about them when i’m on the midst of them. When I talk about them it is always in the past, as some defect in me that I have wonderfully overcome and put behind me in no ones strength but my own. Which is all nonsense of course but this is what I would have you believe. And if i’m in the wrong, expect not an apology at the time, or an admission that someone else was right, but simply a long brood and a belated apology so full of justification and self-righteousness that you would probably have forgotten it began as an apology by the time I had finished.

4) that I must be all things to all people. Not so that by all means I may save some but that all will like me. I get on with nearly everyone. It takes an awful lot for me to say ‘i don’t like so and so’. But I depend on getting on with everyone and fear confrontation and creating a negative image of myself before anyone.

5) happiness is to be feared. The golden rule, that all men do what pleases them, even the man who comits suicide, was something I wanted to pretend did not exist. That happiness and joy in anything I did was obviously because it was wrong and ‘selfish’ in the old childhood sense of the word. Like in vanilla sky, where david screws up the lucid dream on purpose cause it’s like the sweet without the sour and he knows it’s all too good to be true. (i probably got much more out of vanilla sky than was actually there!) I suppose that’s like me. My whole life just seems a bit too good to be true and instead of thanks and praise I question its whole essence.

With luck most of you have either drifted off or have no idea what i’m talking about. This is just a taster of what I could go on for hours about, I haven’t even got to the rules about women yet. But i’m not quite ready for that one yet.

The worm hole

Time flies. Usually with the addition, ‘when you’re having fun’. I find it generally always flies. Maybe I’m always having fun. It was always more as a kid that I thought time dragged. Like in the back of a car travelling to Cork with the endless ‘are we there yet?’ I must have been (past tense naturally) an annoying wee twerp.

The worst job I ever worked in, not that there have been that many, was in a garlic bread factory. Not pleasant as you can imagine. It was just after I finished my A-levels and there were threats of laundry not being done and food not being served if I didn’t get off my bum. Kind of justified.

So I ended up in this place through the wonders of a recruitment agency. I had a glowing CV and I’m sure it was my beating heart and lack of criminal record that landed me the job. And there was me naively thinking they might take brain surgeons just after their A-levels.

The place sucked. It was a noisy, conveyor belt thing, where little slices of frozen garlic bread came through a window from some other room (in fact I never found out where they came from, maybe they just appeared in the room through some worm-hole from another, more galricky universe, I doubt it though…) and my task was to put 5 (not 6 mind you) slices in a little plastic tray before it entered from cellophane wrapping machine.

I remember the same summer one of my mates, who worked in Moy Park, told me that he’d seen a guy lose a finger in one of their machines. I felt bad for the guy’s finger, but worse for the fact that I didn’t have any cool stories to tell. Except that guy who fell in the worm-hole but no one believed me…

You had to wear lovely white overalls, a hair net and lovely shiny gloves that didn’t fit. It was freezing so generally you had to wear a few layers even under the overalls. It was so noisy that you couldn’t even speak to folk beside you. Given the boredom of the job, a conversation would have been a pleasant way to pass the time.  But no joy, you could try shouting above the conveyor belt, but you would have to repeat yourself so many times that you’d lose concentration on your slices, and all of a sudden there’s be 7 slices in a tray and the cellophane machine would jam and then you’d have scary, facially challenged, Margaret (I’ve no idea if she was called Margaret, I had that little contact with her on a human level that she left no impact on my life) shouting at you.

At your precious, 15min break times, you’d sit alone in a changing room, eating garlic flavoured sandwhiches (everything tasted of garlic) while everyone else went to smoke in a dingy smoke room. Maybe that was the only way to get away from the smell of garlic.

After my first day, I knew things would have to change. I brought a book (Sophie’s World – brief, narritive history of philosophy, great book) of my brothers and sat in the car, eating my lunch and listening to the same Delirious tape over and over and again (King of fools incidentally, now always brings back bad memories. Unfortunate, not a bad album).

There’d be occasional brilliant moments when the supervisor would send you on some task, like to bring the pallet truck into the cold store. A job like that was a joy, freedom, in whatever limited capacity, for a few minutes. The coldness of the cold store would take your breath away. I would wonder how long I could stay there before anyone noticed, or indeed, before I would freeze to death. Guilt always got the better of me and i’d go back to the worm-hole.

I had planned to blog about how time has flown since I’ve arrived but I’ve digressed so far that it’s now quicker to go on than go back. Sorry. Though not sure what for.

Where the garlic bread thing leads is this. Because I was reading Sophie’s World, I would philosophise my time away between each break, musing over what I’d just read. Is the garlic bread really there, or is it all an illusion. Are these people a figment of my imagination. If a tree falls in a forest and no one hears it, does it make a noise? Real Phd type stuff.

But I got thinking about memory and came up with this – which would be worse:

a) to have to work a full 12 hr (6am to 6pm, that job sucked) shift packing garlic bread, and experience the fullness of the cold, garlic and boredom of it all BUT at the end of the shift the memory would be wiped from your head, as if the previous 12 hrs of your life did not exist.

b)To spend a day at home, doing lots of fun stuff, having a great time, getting paid for it BUT come 6pm to have 12 hrs of the full garlic bread experience implanted into your head as a memory.

I never decided either way. I edged towards b) cause I didn’t actually have any work to do in that one. But then in philosophy the answer is hardly the point. Kind of the whole problem with philosophy isn’t it.

Four weeks later I spilled my bottle of juice over Sophie’s World while I was eating my lunch in the car listening to ‘King or Cripple’ and that was the end of that. Well that and I quit work and spent the next week in the shower with various industrial agents (cleaning agents, not the ‘hi I’m agent Smith of the association of industrialists’ type agent) trying to get rid of the smell of garlic.

Those poor bunnies

Most places you work in have occupational health people. To make sure you’re not gonna be some health liabilty before you start. For medics, this means you need to be vaccinated against some lovely diseases and also that you don’t have any lovely diseases to give the patients.

My experience with OH people is always that they’re a bit intense, a bit weird. This is on a vast experience of at least three of them. Now my apologies if you know some OH people and I’m offending you. That’s not my intention. But maybe this level of intesnity and caring about things that no body else does is required on the job. They’re not wrong I just find it hard to agree with them  with the same amount of oomph.

Sorry for the rampant judgementalism, but it’s what I do in blogs. I don’t really mean it. There’s lots of things I feel and think on first impressions but reason will always (i hope) dominate my actions.

So… The one in the hospital is lovely but very (very) keen to ensure i’m not imorting the lovely MRSA into the population. Now i’ve written on this before but things changed today.

I got a discreet phone call from the OH woman today, let’s call her Margaret because… well… that’s her name and I don’t think confidentiality is an issue here. Well it wasn’t even a call it was a subtle message to my pager. All it read was ‘call 2601’. No name, no reason.

Incidentally in the hospital here you can send text messages to people’s pagers. You can send them to all the docs at once. Worked well till they had a juniors vs seniors cricket match and then some text banter got out of hand and all of a sudden it was a bit personal, and a bit sensational and the papers would have had a field day. So they stopped that.

Anyhow I got the feeling Margaret would have added ‘turn around slowly and head towards the phone on your left, when it rings say the password and act normal’. But she didn’t and i’m grateful.

I rang the number and once the decryption kicked in Margaret answered and told me to call by her office. Again I got the feeling she would have added ‘come alone, and make sure you’re not followed’ but she obviously knew that ‘they’ were listening so she left at that.

I called round to her windowed office and sat down. She pulled the curtains. I got scared. This was a lady who stuck a needle with TB in it into me on monday just for reaction. OK so that was to prove I was immune but still…

‘Well Andrew your swab results are back’. And I knew what was coming. Cause it was a foregone conclusion. Yes… I was MRSA positive. As surprising as a sunset, or a kiwi liking rugby or a 6hr waiting time in an A&E department.

I think she expected me to cry, or even sniffle a bit, so I obliged by pinching the inside of my leg with my hand in my pocket and thought of watership down (so sad, all those poor bunnies…). I was going to follow that with a ‘how long do I have doc’, but I was pushing my luck already.

So I ended up getting re-swabbed up my nose, my face and places I dare not speak of before the watershed. Always wondered why they made the sticks on those swabs so long…

I’m still allowed to work but I have to walk round the hospital ringing a bell and shouting ‘unclean’. Well no, I just made that up (though the rest is mostly true), I had to get a prescription for body wash stuff (yeah I know i’ll have to start washing) and lovely antibiotic ointment to stick up my nose.

The ointment provides an interesting conundrum. All they give you is the ointment and instructions to rub 1cm of it (i know, what the flip is a cm of ointment when it’s at home) up my nose twice a day. So I now spend 5 mins every morning with my little finger up my nose rubbing this stuff around. All it does is make my eyes water and sneeze.

The idea is to clear ‘nasal carriage’ of MRSA. Though this seems a bit silly since it’s been at 6 months since I examined or treated a patient using my nose. Nasal-led surgery is now largely discredited and illegal in many countries so I reckon the patients were safe anyhow.

I’m tempted not to go through this ludicrous ‘decontamination’ but they re-swab me next week and I think if I fail again I might end up deported or sent to Tasmania, or the south island or worse. Probably lurgan…

Margaret complained that things like this always happen on a friday, and that last friday a similar thing happened when she got the results of a staff members bloods back. They’d got a ‘needlestick injury’ (sticking a dirty needle in yourself by mistake) off a patient. This staff member’s HIV test had come back positive because of it. I was genuinely shocked and enquired what happened next, disturbed by the fact that she would compare that event to mine. She said it was a ‘false positive’ (faulty result) and laughed as she stuffed the swab up my nose. I edged slowly toward the door, stifled a fearful sniffle and tried not to think of all those poor bunnies.

Andre

I’m not known for patience. Perhaps it’s a family thing. My da will usually sneak back out to the garage arfter dinner to do more work to avoid the 90 secs he might have to wait for his cup of tea to be ready. He has this little ‘manic, obsessive’ trait that comes out from time to time. I use those words cause that’s how he describes me when i’m in one of those moods.

This impatience extends to everything, be it making food (what do you mean microwave for 60 secs, I could be dead by then!), exams (no, I’m not checking the answers to the MCQs, once they’re done they’re done), conversation (get to the flippin point!), technology (if a device has a standby that I don’t have to turn it fully off i’ll use it), and work (i used to triage, examine, treat and dispense my own drugs, and discharge patients in A&E before nursing staff even got near them).

And so i’ve been in NZ (from now on, new zealand will be referred to as NZ, so get used to it) for the grand total of 1 week. And I still don’t feel settled, or at home. Now to most people this would be perfectly normal, i’m not meant to be settled yet. I’m still meant to be recovering from jet lag.

Yet I, expected to arrive as a fully-fledged Kiwi, where everyone knew me and I knew them and we were all a wonderful happy family and I knew where the forms were and how the phones worked and the price of cheese and somewhere to live and the silly rule where someone turning across the lane of traffic has right of way and people wouldn’t think I was called andrè when I say andrew and this is a very long sentence with minimal punctuation so i’ll stop and we can have a collective indrawing of breath.

And so I need to stop. And ‘chill’ so to speak and give things a bit of time and stop chomping at the bit at everything.

Funny, i’ve been here only a week and i’ve learnt stuff about myself that I didn’t even realise was there. Kind of cool.

Now da would argue that he’s known all this for years and there’d be a mighty ‘i told you so’ and a ‘you should listen to me more often’ but then he probably lost patience during the very long sentence earlier and is off in the shed categorising all his screws and nails.


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September 2006
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