Hello, my name is Joseph. I am a rad onc reg and here is how today looked like for me:

7:30am
Woke up before my alarm went off. I was knackered, but I had too much swirling in my mind so I got up without the alarm (a true rarity of rarity) and had a tired cup of coffee and a bowl of microwaved oat. Most of the consultants in the rad onc department have been away and it has been quite stressful covering the workload at my level. So remembering this I said a little prayer for an extra portion of love, joy, peace and patience for today. Wait…, this is not how I should start this entry off!! I do love my job, very much.

9am
The morning started with the weekly Patient Care Meeting to discuss issues with patients starting radiation treatment this week. I met most of the patients in their initial visits but I can’t remember the details for half of them. It must be because I was still trying to wake up.

10am
In the radiotherapy planning section (a room filled with computers churning out dosimetric data) to answer some questions the radiotherapists had. I ran a few questions past a consultant about two complex patients.

11am
Got into the shuttle bus that takes me from the Repat hospital campus to the main hospital campus to see some inpatients requiring radiation oncology consult. So there was this young 27 year old guy with two cancers who, despite everything, was fortunate enough to have a spinal lesion detected in time to have neurosurgery before he became paralytic.

Halfway through talking to him and his partner I got called by the department, asking me to return urgently. Apparently a patient with a large epiglottic SCC was actively coughing up fresh blood. Yikes! But let’s call him Mr. A. The Head & Neck consultant was away so it came to me to have to do a fibreoptic naso-endosocopy to determine the source of bleeding.

11:30am
While walking to the shuttle bus stop to take me back, I bumped into a church friend who worked in the hospital lab. She seemed stressed about her PhD thesis writing and her upcoming thesis oration. I wish I could stay a little longer to listen to her but I had to rush back to save my bleeding patient. Yeah.

In the shuttle bus I met the oncology services research trials coordinator. In the 8-minute bus trip, I tried to cover the fact that I have been rather remiss with my research projects.

12pm
So I scoped Mr. A and found that he was indeed bleeding from the cancer, but the bleeding had stopped. The other thing I noted was that the tumour had in fact grown remarkably since I last scoped him a few weeks ago. But not to worry, because I have perfected the skill of acting unsurprised when I went through medical school. I briefly told him and his wife what I found, but in my mind I was thinking it was probably a kind thing that they didn’t know what they were looking at.

I wanted Mr. A to be admitted to hospital for observation, but I made a few phone calls to St. Vincent’s and the Austin’s ENT teams first to make sure there weren’t any surgical intervention possible. Then I called the hospital bed manager and the medical oncology registrar to ask them to kindly look after Mr. A in the wards.

1:30pm
While making the phone calls I was asked to see another patient whose oxygen levels were desaturating during treatment. Let’s call her Mrs. B. When I got to see her, her pulse oximetry was indeed only 87% at room air. Her hands were blue and she appeared drowsy. So I stabbed her radial artery to get a millilitre of arterial blood to check for blood gases (always glad to get my hands dirty), asked the nurses to take some venous blood and sent her for an urgent chest X-ray.

2:30pm
While the tests were being sent away I hadn’t quite made up my mind about what to do with her, but I knew I was feeling faint and seeing some starry sights. I am familiar with this feeling. I get this feeling whenever I miss meals. I stopped to eat lunch, but then abandoned my food halfway because my crappily cooked pasta with tuna and el cheapo pasta sauce was not appetising at all.

3pm
I was now due to be at the lymphoma clinic to see patients on behalf of the professor who is away. I knew I would be at the clinic until late, and I wouldn’t be able to be back in time to check on Mrs. B’s results to know what to do with her. So I decided to send her to the Emergency Department to be managed there. She wasn’t very keen on the idea but oh well, it was all I could do with the resources I had.

5:30pm
I whipped through the patients in the lymphoma clinic. Four patients with their cancers cured and happy, but one had progression of disease and was no longer curable. He seemed to take the bad news alright however. He had a daughter who was a fourth year medical student who explained quite well that a “lobe” in his context referred to his lung lobes and not his earlobe.

6pm
I got back to my department and started feeling really weak and hungry again. So I stole the key and snuck into the locked dietitian’s office and helped myself to a packet of Novasource drinks — high-calorie dietary supplements for patients who can’t eat solids well. Probably the best thing I’ve done today!

Just as I sat down in a dark room thinking of looking through some CT and PET image fusions, the family of Mr. A came asking for me. They had driven straight from the main hospital campus in the now rapidly darkening skies, looking extremely upset. Apparently when Mr. A got admitted to the oncology wards earlier today, the ward doctor there was a little too blunt and offended them a bit. The poor wife in particular appeared quite shaken. So I sat them down in a private room and went through the whole situation again and tried to explain the different possible scenarios that could happen. I really felt for them. There is a tyre puncture somewhere in the story too but I won’t talk about it here.

6:30pm
At the end of the discussion I said “we can only take it as it comes, day by day”, but immediately realised I was being a jackass by saying that. It is always easy for a third party person to say “don’t think too much”, but sometimes you just can’t help the swirling thoughts in the mind. I have experienced it for example during job applications, and I had just experienced it last night and this morning too. The family seemed a little more settled as they walked out but I am sure they were suffering.

I took a little time to debrief with the last remaining nurse in the department. She raised up the idea that Mr. A could even pass away that night. Not impossible of course, but I truly shudder to think of the repercussions for the family if that happened.

7pm
I usually cook to save money but I was way too tired. I felt like buying pizza to eat for dinner but the neighbourhood pizza joint wasn’t open. So I got McDonald’s instead. I do like my food but since I drank Novasource today, McDonald’s was a treat.

Sitting here in my room now, I briefly bring to mind the research projects I have been wanting to work on (and am glad that being in Melbourne allows me these research opportunities), and the clinical assignments I have left unfinished for too long, but ah, there will always be tomorrow. I will at least read the Bible tonight though.

And ladies and gentlemen, this is the day of a radiation oncology registrar!

Okay, maybe not everyday is like this, but as you can see, there is a lot of fun.

Yours sincerely,
Joseph

Sitting in the clinic room a few weeks into treatment, I asked him how he was. He let off a sigh. He took off his cap to reveal his scalp — a little red from the radiation treatment, with irregular patches of baldness. Whatever hair he had left, it was very short.

“What can I say. When I was told I got brain cancer five years ago,” he said, “I told myself I’m gonna change. Stop bumming around and get my life together. All my life, it’s all been about footie, but I told myself to stop. I wanted to do something meaningful y’know. Maybe some traveling.

“But here I am and I’m still the same. It’s the new AFL season again. Richmond lost last week and my whole week’s been depressed. Who knows if we won, maybe I wouldn’t be so affected.

“It’s been how long…,” he paused a little while. “Still the same. Got nothing done.” Possibly with a hint of knowing that he may not have many more years to go, yet still the same.

1. Steak is quick and easy to cook and clean up, and tastes so good with the right spices.
2. One of the perks of working in oncology is the frequent chocolates and fruits that we kindly receive from patients. The best cheesecake I’ve had by far is made by a patient (so good).
3. What is even more inspiring is how some of the poorer patients give the best gifts — boxes of “high-end” chocolates from the local supermarket for each and every staff member (not a trifle amount), or a good sum of money donated despite their financial circumstances — from the poorer patients.
4. An hour of walking to the supermarket, shopping, and walking back is worth more than an hour in front of the computer thinking that you are relaxing.
5. When going out for dinner with colleagues, order an entrée to share with everyone.
6. Higher octane fuel, although more expensive per litre, works out cheaper as you get more mileage out of it, and the engine is smoother to drive.
7. Happiness in life is partly related to discipline (the discipline to sleep on time, get stuff done, refrain from certain things etc) — without discipline, life is unbalanced and unhappy.
8. When motivation is waning and you are questioning whether you should be going to the gym, the answer is yes you should go.
9. When trying to be frugal in saving up for something, do not forget to be generous in everyday life.
10. Accidents happen often because things are not put back to where they are supposed be.

Surely there are many more, but here are some of them. Happy 2012 too! (Yes, it is already one month into the new year.)

If you have your tips of wisdom please share too.

This is my first time shooting a wedding in Malaysia. While there were some minor differences in wedding customs, the excitement and jubilee were just as infectious. Allen is my cousin, and it was my first time meeting his long-time girlfriend Amy. It was a real joy to catch up with extended family after so long too.

It has been a while since I touched my aging camera (proof of how amateurish I am), but it was fun looking at the world through the viewfinder once again. Here is to say congratulations, and all the very best wishes to Allen and Amy in the years to come!

That’s my nephew, during the wedding reception, by the way.

As you may expect, now on top of my hospital work I have clinical assignments and self-study to do. With a small change in priorities, it is inevitable that I will be updating this blog less often, at least for now. I will definitely still be writing – and I still have many things I want to do! – but I will just be updating less often.

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Thank you to those of you who are still reading. Write to me because I would still love to hear from you!

She was Jerry’s granddaughter. She just turned twenty not too long ago and she was getting married soon. She spun around once in the room, her hands in elbow-length white gloves held the hem of her white flowing gown high to show her grandfather, and I caught a glimpse of the ring on her finger. She was partly embarrassed, partly proud, and Jerry watched with part smile, part unbelief. Jerry was the most pleasant elderly man, even with the physical pain we knew he was going through at his terminal stage. A week ago he was still walking about when he saw us in the clinic, but a few days later we paid him a visit in the Emergency Department, and now a nasogastric tube hung from his left nostril, draining material from his bowels. His bowels were no longer working due to a combination of cancer and scarring from previous surgery and radiotherapy.

But for that moment, I thought, there was so much overwhelming joy in that little crowded single room. The two of us stood there as uninvited guests, but thankfully welcomed by Jerry and his son and his daughter-in-law to join in the thrill.

If I could capture those moments in video — the girl with the puffed bouffant skirt of her gown trying to find a comfortable position stooping beside her grandfather on the hospital bed for a photo, her mother trying to work the camera with her presbyopia, her father standing beside in his tradesman work clothes, and the relatives watching and laughing and making comments amongst themselves — I don’t think I would even need to put music to it to bring a tear to those watching it.

When she was in her teens, she had a boyfriend. She decided to tell her boyfriend that her right eye was actually fake, and her boyfriend left her immediately.

Later in her twenties she met a guy, and they fell in love and got together. When she was deliberating whether to tell this guy the truth about her eyes, there was anxiety and she wasn’t sure what to expect.

But she told him the truth — and the guy looked at her and replied, “So what? I’ve only got one eye too.”

Just a few years ago, the guy had got into a major motor vehicle accident with severe facial trauma and skull fractures. The doctors had to fix a metal plate in his forehead and tie his left cheekbone together with wires. His left eye was still intact, but the optic nerves had been cut. The scars have healed up well now and only a very slight displacement of his left eye is what remains. Just by looking at him, you couldn’t tell that he was seeing only from his right eye. She had not known until then.

“I guess we were made for each other,” the woman said to me, sitting beside him. They are soon approaching their seventies, and have been together as husband and wife for more than forty years now. This is a true story.

He came in when I was working in the aboriginal GP clinic in the Northern Territory, wanting to have a check up for sexually-transmitted diseases.

He had good intentions, if I dare say. I could sense his frustration at knowing what is right and not living it out — and don’t we all know the feeling well. Yet as I talked to him I came to know that he had already made some other changes in his life that was worth commending. Decided to stand up to peer pressure and cut down on alcohol consumption. Starting to pick up the discipline to exercise. “But I still don’t know how to control this sexual urge,” he said as-a-matter-of-factly, “I just can’t control it, y’know.”

He saw the tray of free condoms in the room and grabbed to store more than a few in his pocket, with some embarrassment. I never paid much attention to that tray — now I know how important it is to refill it!

“How would you feel if your partner did the same?” I asked.

“Oh I’ve heard that one before. … But I won’t do it when I get married, it’ll be different,” he answered.

“How do you know you can control yourself after you get married, when you can’t do it now?”

“Yeah,” he shook his shoulders. I was sure the question had crossed his mind before too.

I opened my mouth but I stumbled to take it much further. If I said anything more, I felt, I would have been a true hypocrite. It doesn’t have to be sexual dishonesty. My words would come back to bite me.

What makes a good wedding? There were no white Mercedes convertibles parked outside the church. No Christian Louboutin stilettos in the dressing room. No Tiffany & Co. diamonds on the altar. The location was not an exotic paradise in Bali. The hands were not immaculately manicured; they showed signs of hard work. There was no front put up to impress, and the people who turned up you could relate to everyday.

This is an honest girl being wed to an honest boy. All the very best for Melvin and Eunice. Thanks for letting me be part of this joyous celebration.

Many other natural disasters continued to occur throughout the world, of course, and I later crossed the Tasman Sea to move to Australia just after the earthquake in Haiti hit in early 2010. It was then the anniversary of the Black Saturday bushfires that licked up a huge part of Victoria the year before. People were recounting the horror stories over radio.

Then the major floods in Queensland happened only a thousand kilometres from where I was staying, followed by Cyclone Yasi sweeping the northern parts of the same state. This time I had actual friends and people whom I knew who were in the area. Cyclone Carlos followed shortly after to hit Darwin in the Northern Territory — and I have only just been to the place earlier in 2010! The photos in the news were scarily familiar — yet now barely recognisable with the flooding, fallen trees and flattened houses on places that I have just stood in not too long ago.

And then the earthquake struck Christchurch, New Zealand, just yesterday, this time levelling the city area, catching all of us completely off-guard. My two brothers are there, and it was amazing to hear their first-hand experiences of the hospital blacking-out, being evacuated, and the general destruction of the city. It is unthinkable to imagine Christchurch without the century-old landmark buildings now — the day surely is history-changing.

I was flicking through my phone’s text messages when the earthquake happened, and the happy text messages only from a week ago of a friend finally finding a job in Christchurch, and of my brothers inviting me to play a game online together with them, suddenly seemed so distant and irrelevant now. Oh how things can change in a blink of an eye.

It is amazing too how these happenings seem to be getting scarily close both on Earth and in heart — in neighbouring states and in places I have grown up in. It is even more frightening, however, to think of how I can turn my eyes away from the news, walk along streets of Melbourne suburbs and immediately so easily get hypnotised by the calmness here.

I can’t help but to think it is not evitable that a disaster will strike my location one of these days. It almost feels like a guilty conscience! When and how would that be? Would I have a family of my own at that time? Who knows it will come when I least expect it.

It crossed my mind that if someone said, “Repent, for the kingdom of heaven is near” again, would it make more sense now? It is a crazy time we live in these days, how far is this going to go?