“You know the story, cauda equina syndrome, onset since 36 hours ago, excellent response to dexamethasone. Large sacral mass with extensive soft tissue infiltration on MRI, no obvious disease elsewhere on CT CAP,” I started as the consultant walked in, Saturday morning.

Earlier that morning when I arrived at the nursing room, the first thing Jon the oncology nurse did was point with his eyes the lady on the bed across the hallway. “I think that’s the lady you’re looking for,” he smirked.

“Yeah, got a few calls about her last night,” I said as I put my bag down. Six hours of sleep on a weekend was definitely painful. I brought along with me a packet of Up&Go for breakfast which I didn’t get around to even drinking.

I sat later that morning on the bed beside her, hoping to explain the situation for urgent spinal irradiation. Young, fit and well, and suddenly hit with severe back pain. Finally she brought herself to see a doctor two days ago, then in a whirlwind trip of two hospital transfers one on each day, here we were having this discussion. “We found a large lesion in your sacrum, the part near the bottom of your spine, which explains the symptoms you have. It looks bad,” I paused, watching for a response, then continued. “It looks very much like cancer.”

She sort of knew. Afterall, before I said hello to her, from the nurses station I saw her cry, then trying to hide the tissues, then cry again. Yet she had no doors she could close, or a private spot she could withdraw to — there she was, bound to her bed with newly weakened legs, curtains wide open, vulnerable to all the eyes of people walking up and down the hallway.

The conversation last night with the referring hospital’s doctors played back.

“So lower back pain, foot drop, urinary retention and dermatomal parasthesia consistent with imaging findings. I presume she has been started on dex?” I asked against the wind while walking towards the car.

“Yes, 8mg q.i.d,” the neurosurgical resident replied over the phone. She wasn’t on after-hours duty, yet was still at work. Poor her!

“When was it started?”

“Today.”

“I mean what time?”

“Um, around 11am this morning.”

“And has she improved since?”

“I don’t know, we haven’t seen her yet,” she replied, then added, “she’s been in CT most of the day.”

It’s past 8pm now and you haven’t seen her since 11am this morning? “Could you check her neurology again? Or if you’re knocking off can you please get the cover person to do it as soon as possible?”

“No I can do it. The reg and I will be doing a ward round soon so we’ll examine her again and I’ll let you know. Can I call you on your mobile when we see her?”

“Please do,” I replied, a little anxious, “and who am I speaking with?”

“I’m Tam.”

“Thank you Tam. Speak to you soon.”

But I didn’t speak to her again. It was the neurosurgical registrar who called me about an hour later. It turns out dexamethasone has reversed most of her neurological deficits. Thankfully. That buys us some time, and she will less likely be paralytic for the rest of her life if we could treat her urgently the next morning.

“Is it common for you to do ward rounds at 8pm on a Friday?” I asked at the end.

“It is when we finish operating at 7,” the neurosurgical registrar replied, without hesitation and almost with a hint of pride, ever so confident as a surgeon.

Yeah, but you let an inoperable young patient with an oncological emergency sit under your care since early this morning, and only seek radiation oncology input now at your convenience!

I hate criticising in thought and I hate it when I become grumbly. I am just as prone to the mistakes that I criticise in other people. I remember the many times when I so easily get swamped by the “jobs” that have to be worked through in the day, and neglect less obvious but more important matters.

Even that morning when I was talking to her while answering the interrupting phone calls and trying to keep the Saturday morning chaos under control, it came to me how easy it was to forget that this lady was a professional gymnast turned high school teacher. That that she had two children and one granddaughter who love her and were trying to keep track of where she and her clothes were after all the hospital and ward transfers. That her mother was still alive and lucid at 89 years old, living alone in an independent unit, not yet informed of the bad scan findings. And here, there was a chance she could never have been able to stand again, or have control of her bladder and bowels again. It is frightening how the impacts on her life — irreversible and unspeakably huge — do not register, and become so distant, when I forget.

“What happened 3 years ago?” I was asking her that morning, after she told me she used to be a busy woman and gym fanatic but stopped, 3 years ago.

“Aw, had a shift in priorities? My granddaughter was born that year… and I realised I just want to spend lots of time with her, and family, when I get home everyday.”

I stopped prodding more because it felt too much like one of those tragic flashback foreshadowings in an animated film.

I couldn’t sleep well that night. The pillows were stacked too high, the duvet was too warm, the cheap fan was creaking too loud. Somewhere along walking back and tossing around in bed, I realised too that when we find ourselves so detached and numb that patients become just another printed line of capital serif letters on the paper list that we look at and think the shorter the better, it is time to probably take a break, and fill our emotional gauge — with love, and peace, just maybe. Amidst the frustrations and busyness, and more frustrations, people are still important, and it is easy to forget.

(There are 4 responses to this post.)

This friendly guy had a stable girlfriend. Yet he was having sex with other girls, unbeknownst to his partner, and he was still doing it. Without condoms too, because he didn’t have them around when the situation called. He had already made two women pregnant. He already had a few children around in the community. He confessed to me.

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.

(There are 8 responses to this post.)

When the world was ghastly shook with news of the tsunami in Indonesia in 2004 and the earthquake in Sichuan, China in 2008, I counted my blessing to be living in New Zealand, tucked away safely in a tidy corner of Earth’s colonisation.

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?

(There are 5 responses to this post.)
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