Traversing Canterbury

After waking up at eight, James and I have a leisurely morning start. Today’s ride will take us across the Canterbury plains and finish in Springfield at the foothill of the Southern Alps.

The road quickly takes us out of Christchurch. After turning off the main highway onto the Old West Coast Road, shops and suburban houses on either side of the road are replaced by pine trees, hiding behind which are estates of the wealthy, by the looks of it. With an overcast sky and the scent of pine blowing in the air, the setting has quite an English character to it. Gradually, the pine trees disappear, sheep and cattle farms have now become the major scenery. With very little traffic and perfectly flat, this road is great for cycling.

At around lunch time, we stop at a cherry farm to buy some expensive but freshly picked and delicious cherries. Sitting down at the whitewashed wrought iron table and chairs under a tree at the farm’s garden, we brew some tea and have avocado and tuna sandwiches for lunch. The whole setting is just a little too prim and proper for two guys like us.

James setting up for lunch

For the rest of the afternoon, the scenery remains the same: farms for as far as the eye can see. The quietness is occasionally punctuated by cars passing, sheep bleeting, and cows mooing.

Freshly-shorn sheep having a staring contest with me

The last ten kilometers of the ride is gently ascending – only a gain of two hundred meters in elevation – so gentle is the gradient that it is visually imperceptible. But as a sign of my legs being out of shape, my legs are burning with every stroke of the ride. Soon my thighs feel as if they are dissolving in the lactic acid built-up in them. Finally, with my last ounce of strength, I follow James to the campground just outside of the town of Springfield.

The tiny Sheffield has a 24-hour petrol station

James hanging out by the toilets

Summer days in the South Island are long. The sun comes up at six a.m. but does not set until 9:30 p.m. We cook dinner, shower, and get ready for bed. Both James and I are sleeping in hammocks. They are not the mesh hammocks found everywhere in the tropic islands. Instead, they are especially made for camping. When you get into it, you are completely enclosed inside. A rain fly over it keeps you dry in case it rains.

Our hammocks all set up

Cooking dinner

View of the mountains from the campground

In the middle of the night, I wake up and find that I have become a popsicle. Because the hammock is set up off the ground, cold air from below can suck your body heat away quite efficiently. Not prepared for nights this cold, I get up and put on most of my clothes. Still, the part of my body in contact with the bottom of the hammock is cold even when the rest of me is warm enough. I drift in and out of consciousness, constantly shifting to prevent my toes from falling off or my shoulder or back from turning into ice blocks.

At six o’clock, the sun is rising. I give up trying to sleep and get up. James has had a similarly awful night. We will have to find a way to solve this problem.

Stats:

Distance: 65.1 km
Time: 3h 20m
Max speed: 33.7 kmph
Average speed: 19.5 kmph

NZ Bound

Wow, the last month went by so fast, it felt like a week. At first I thought, “What am I going to do for a month in Fresno? I’m going to be bored out of my mind!” As it turned out, between spending time with family, visiting friends, and getting ready for my cycling trip to New Zealand, there was hardly time to get bored.

A week was taken up by going to Washington, DC, where I had lived for seven years and still have friends around. The hectic life and horrendous traffic of DC really made me appreciate the much more laid-back lifestyle of Brisbane. Give me an overgrown country town any day; I can do without the constant rush to the next place.

The rest of the time, I spent catching up with my extended family, high school friends who are now high power lawyers and movers and shakers in the tech world, and playing with my nephew and watching him grow. After learning to crawl the day before Thanksgiving, my nephew can now walk a few steps while holding on to the edge of the couch. I am sure in no time he is going to be able to walk on his own and start to be a menace to the whole family because then, the whole house will have to be childproofed.

There is always a level of sadness whenever I leave my family; it is especially so this time. Maybe it is because I am now thirty-one and no longer have to assert my independence. Maybe when your age starts with the number “3,” things start to change: life becomes less about rebellion and exploration and pushing boundaries and family becomes important again.

With this thought in mind, I gave my mother and sister a hug and boarded the flight from Los Angeles to Auckland, New Zealand. On my way back to Australia, I am first going to have a little adventure in New Zealand. My good mate James and I are going to ride out bicycles around the South Island for eighteen days. Not a bad way to ring in the New Year and have one last hurrah before putting our noses to the grindstone again for our final year of medical school.

I sleep fitfully on the plane through the twelve-hour flight. Upon landing, I reassure the customs officer that I am not intending to stay in New Zealand illegally and head to the carousel for my luggage. I am relieved to find my bike box stacked neatly with other oversized bags. After the fiasco with my bike on my way to California a month earlier, I really don’t want it lost again. I collect my bags and head to the domestic terminal for my connecting flight to Christchurch in the South Island.

View of the Southern Alps from the air

The bus drops me off at Cathedral Square where I am supposed to meet up with James. As I am more than an hour early, I start to take my bike out of the box and assemble it under the shadows of the magnificent cathedral. An hour later, James walks up. Awesome! Everything is working according to plans.

Playing chess in front of the Christchurch Cathedral

We find accommodation for the night at a caravan park. We will sleep in luxury – in beds – because camping is in store for the next seventeen days.

Lost and Found

After numerous phone calls back and forth between myself and the New Zealand Airlines baggage center in L.A., my bike was finally located, flown to L.A., and delivered to my place today. It apparently had never left Brisbane in the first place. Arghh! That's five days from the time I left Brisbane to the time they delivered the bike to me. I am glad it turned up again, but I really hope they do a better job and actually put the box on the plane when I leave for NZ at the end of December. I don't want to spent a quarter of my time in NZ holed up in Auckland waiting for my bike.

Hey Little Dude!

My nephew Ethan is almost eight months old. When he first saw me at the train station, he wasn't quite sure how to react, but warmed up to me after a couple of hours.

He is so cute - when he's not crying.

The Long Way Home

I am packing, not for going home, but for my cycling trip in New Zealand on my way back to Australia. Going home is the easy part, packing-wise. I am sure I have some clothes left at home to wear, but packing for the cycling trip requires a lot of planning, much more than my cycling trip to Vietnam last year.

Packing for a cycling trip to Vietnam was so easy, I did it in half an hour. In Vietnam, food was good, cheap, and everywhere; cheap accommodation was also found everywhere. So it was like a catered trip. New Zealand, on the other hand, is much more sparsely populated and things are not cheap. So I will have to bring all of my camping gear, making the packing a bit more complicated. So I take out my packing list for a cycling trip and my packing list for a camping trip, get a box from a bike shop, and get to work.

And, with my bike taken apart and put into the box and everything else in a duffel bag, I am ready to go.

Auckland from the air

My flights from Brisbane to L.A. via Auckland are uneventful. After clearing immigration at LAX, I stroll over to baggage claim. My duffel comes tumbling down the carousel, but my bike is nowhere to be seen. I stand and wait by the odd-size baggage area. As the baggage area clears of people from the flight, I know something is not right. A brief chat with the baggage guy confirms my suspicion: they have lost my bike. Well, at least they have lost it now, and hopefully not when I am in New Zealand and needing my bike a month from now. I fill out a form and walk out of the airport terminal unencumbered.

Next, at the train station, I find out that train tickets to Fresno are all sold out for the day. Oh, right, it is the Sunday after Thanksgiving - everyone is traveling. It did not occur to me to book my train ticket ahead of time; I didn't think that many people actually travel by train in the US. Apparently I was wrong. So I crash the night at my cousin's place.

On Monday morning, with train tickets in hand, I board the bus for Bakersfield. I have to travel by bus over the mountains north of L.A. into the Central Valley of California, then pick up the train in Bakersfield where the train line starts.

Twenty miles out of Bakersfield, the train comes to a halt. After a while, the speakers crackle to life. The conductor announce that a freight train in front of us had hit a truck at a crossing, someone was killed, so we have to go back to Bakersfield. In Bakersfield, the bus takes us around the site of the accident to Wasco, where we board another train. Six-and-half hours after leaving L.A., I finally get to Hanford train station, where my mom, my sister, and my little nephew have been waiting.

I am finally home! But my bike is still lost, sitting somewhere in Brisbane, Auckland, or LAX.

Black Friday Frenzy

It is three o'clock in the morning, snow is falling, covering everything in sight in a light blanket of ghostly white powder. The faint moonlight reflects off the snow, casting eerie shadows on the long line of people waiting outside the store. The line of people have been there for a while now. Some are covered in heavy blankets, asleep but mindful of their surroundings lest someone cuts in line, some are huddling together, some are stomping their feet to wake up their frozen toes, some are sipping on cups of fast cooling coffee. Just one more hour before the store opens, inside is what these people have been waiting for, something so essential that people would forgo their dinner the night before just so they can wait at the head of the line. As the clock strikes four, the doors to the store clank open. The people surge forward, eagerly lurch inside, and elbow their way through before everything is sold out.

This may sound like people in the Soviet Union waiting in line for bread, but it is actually how I imagine the scenes of people waiting in line for the Black Friday sale in the United States.

I was reading the news online and came across articles describing the frenzy of shopping the day after Thanksgiving. I couldn't help but notice the parallel between the bread lines of the Soviet Union and the "electronics lines" of the United States. In both cases, line are created when demand outstrips supply. The main difference is our "electronics lines" are formed voluntarily. The demand is not for basic necessities of life, but perceived need created by advertising and our way of life. The lengths people would go to "save" money are astonishing: missing Thanksgiving dinner, braving the cold, risking bodily harm, and generally enduring self-inflicted misery. Is buying something you don't need for half off really saving money?

Later, Hervey Bay

I didn't think I have that much stuff. But after I put everything in boxes, backpacks, and bags, the spread in the living room starts to get me worried. I may not be able to fit everything into my little car. A second trip - an extra eight hours - is looking depressingly likely.

Not one to be discouraged, I fold down the backseat and start putting boxes into the car. One after another, bit by bit, every inch of room gets filled by my stuff. At the end, as if defying the laws of physics, all of my crap is crammed into the car. I can even see out of the left rear-view mirror!

So with the car packed to capacity, I drive out of the Hervey Bay Maryborough Road for the last time.

Whoa, We’re Halfway There!

Woohoo! Exams are over, and I am a free man for the next two months. How I need the break, especially after such brutal exams yesterday.

The exams were in Bundaberg, a little over an hour away from Hervey Bay. They were horrible. I must have looked terrified while I was sitting in the lobby of the hospital waiting to get called in. Nurses, wardies, and everyone else who walked past me stopped to tell me, “It’s not that bad.” After an excruciatingly long wait, I was finally given my patient. Then the rest happened so fast, I hardly noticed that time just flew by. At the end, the examiner said cryptically, “I’m not allowed to give you feedback at this point. But enjoy your break and I’ll see you next year.” Yeah, hopefully not in the same scenario.

I spent the rest of the day stewing over little details that went wrong in the exams and every answer that I got wrong or needed prompting for and the awkward silences when I didn’t know what to say, until the evening when I got together with a few of the doctors from the medical team and had mulled wine. Ah, alcohol, I am so glad we are friends again.

Today’s plan: pack up everything I own into my car.

Tomorrow: drive to Brisbane.

Sunday: fly out to California.

Next Wednesday: off to Washington, DC.

And that’s just the plans for the next seven days.

It’ll be a good summer break.

Waiting for the Execution

Tomorrow I will be taking the exams for medicine rotation, and I am feeling restless, unable to concentrate, and in complete sympathetic overdrive. Studying? So over it. I have been staring at the pages of my books and nothing seemed to have gotten through. This afternoon, feeling like I was getting nowhere with studying, I went to the pool for a swim. After jumping into the pool, I felt like my arms were made of putty and just wouldn’t cooperate to allow me a good swim. After splashing around in the lane for a half hour, moving like I’d just learned to swim, I gave up and walked back home.

I don’t know why I am feeling so nervous. You’d think after having taken so many exams in my life, it wouldn’t be a big deal anymore. Maybe it’s because the whole exam is live, as opposed to written like almost all of the other exams I’d taken before. Maybe it’s because my grade for the whole rotation will be from the exam tomorrow. Or maybe it’s actually excitement from knowing that I am one day away from a two-month holiday.

I take my pulse. Forty-eight per minute – pretty normal for me. Maybe I am not that nervous after all. But my palms are sweaty and have been for the last three days. I feel like I am waiting for my execution tomorrow, watching the clock tick away, dreading the inevitability of it but, at the same time, looking forward to when it’s over.

All right, no more studying. I am going to watch some video clips on Youtube and hopefully I will get tired at some point.

It's Only A Five-Step Job

I see this sign everyday. It is posted in one of the staff toilets on the medical ward at the hospital where I am doing my medicine rotation.

It only takes five-steps!? And with illustrated instructions!! To change a roll of toilet paper? I wonder how many toilet-paper-roll-changing mishaps it took for someone to take the time to make and post these instructions. But it gets better. Someone else must have thought, “Five steps? That’s too complicated. I’ll simplify things a bit,” and wrote down the “Alternative Directions” next to the printed instructions.

Every time I look at it, I feel like I am reading a manual for defusing bombs. Okay, maybe not, but this is definitely the first time I’ve seen a toilet paper roll holder that needs an owner’s manual.

~~~~~~~~~~

Tonight’s dinner: herbed chicken risotto with green beans, and a salad.

Might Have Been, Could Have Been

I am currently reading Fresh-Air Fiend by Paul Theroux, one of my favorite non-fiction and travel writers. Fresh-Air Fiend is a collection of short stories Theroux has written between 1985 and 2000.

In one of the stories, Theroux recounts his experience as a Peace Corps volunteer in Malawi in the 1960s. As I am reading it, I suddenly remember that I had toyed with the idea of joining the Peace Corps seven years ago. It was a year after I finished college; I was living in Washington, DC, and had a full-time job. Having just been rejected by all the medical schools I applied to around the country, I was asking myself, “What next?” At the time, the adventurous side of me and the conventional side of me were fighting a battle.

It might have been a poster I saw on the street, it might have been something I had in the back of my head all along, or it might have been just something I came across on the internet at the time, I decided to look into the Peace Corps as the next step. I even went to one of their information sessions, which, replete with tales from an enthusiastic volunteer who had just returned from Vladivostok, had the quality of an infomercial at 2 a.m. My interest was piqued nonetheless. I continued to gather information and looked online at discussion forums about the Peace Corps. So the adventurous side of me was gaining an upper hand.

The conventional side of me, not to be outdone, took me to look at PhD and masters programs at graduate schools. I contacted a few professors and flew to a couple of the school to check them out. What they were doing were interesting stuff: things like tissue engineering and research on exercise in microgravity; but none of them made me slap my forehead and say, “Ah-hah! That’s what I want to do!” I returned home feeling ambivalent about what I had seen. Then one day, I heard about a part-time masters program at Johns Hopkins University and decided to drive to their open house after work. And here, the conventional side of me caught up to the adventurous side of me, then passed it. I decided to start the part-time masters program in biomedical engineering at Hopkins.

And abruptly, Peace Corps fell to the wayside. The glossy brochures and the application packet sat in a pile, forgotten, and when I moved house, went to the dumpster with the rest of the garbage. Not long after that, I’d even forgotten that I gave the Peace Corps serious consideration when I was in the crossroads of life in my early twenties. Looking back, I can see that of course the conventional side of me won – it had society and all the cultural weight behind it. The giant arrow painted on the road of life that says, “This way to happiness” – the non-stop conditioning since childhood by both the Chinese and American cultures – made it easy to follow it and assume it to be correct but difficult to see if there were any alternatives. I had gone back to following the giant arrow after veering ever so slightly down a side trail. This is not to say I regret going to grad school. To the contrary, I am glad I did. I am where I am today partly because I chose that path then.

After two years of grad school and full-time work, I asked myself again, “What next?” I could not find an answer. I had the inevitable burn-out at the time. It did not happen overnight. Rather, the feeling had been brewing steadily toward the end of the two years. Graduation was more like a valve that suddenly let out all the steam. I quit my job, sold or gave away most of my worldly possessions, packed my car, and drove back to California. The adventurous side of me had finally taken revenge. What followed was two years of wandering, on and off, in unfamiliar and remote parts of the world. It was one of those “finding oneself” kind of trip, as clichéd as it sounds. I lived out of a backpack and slept in countless nameless hostels and cheap hotels, I ate street food, I took the cheapest public transport I could find. Materially, it was the poorest I’d been, physically, it was the most uncomfortable I’d felt, but it was the period of time when I felt the most alive. Maybe it was the adventurous side of me saying, “See, you should’ve listen to me last time.”

Looking back, I wonder what would have happened if I had listened to the adventurous side of me earlier and joined the Peace Corps instead. I would have learned another language, I would have been sent to some out-of-the-way community in some obscure country to teach or to help set up a community clinic or help in whatever project, I would have been the farthest away from physical comfort and what was familiar. And I would have loved it. That experienced would definitely have changed my life and my life’s trajectory, as it did Theroux’s. I could have settled down somewhere, I could have gone on to other professions, I could have become a constant nomad who incessantly roams the world for the next patch of pasture, I could have…

Instead, I ended up studying medicine in Australia. It was the result of a series of decision-making since high school without looking too far into the future. And it seems to have worked incredibly well for me. Now, the adventurous side of me and the conventional side of me are not fighting a battle, but are playing complementary roles to each other. My rumination on “what if…” is an exercise of imagination on the outcome of a different path I might have taken in life and a reflection of the fact that every choice I make today, no matter how minute it seems at the time, will have an effect on the options I will have in the future. I don’t think I would be any happier now had I chosen to join the Peace Corps seven years ago, nor am I any less happy now for having decided to go to grad school instead. I have absolutely no regrets on any of the life-changing decisions I have made. Dumb luck? Perhaps. But maybe a dash of a sense of adventure, a pinch of embracing the unknown, and a heap of travelers’ optimism all had something to do with it too.

Not the Sharpest Knife

With two weeks of the rotation over, I am finding myself getting less stressed out by not being able to answer the impromptu quizzes thrown my way on a daily basis. I must be getting used to it. On a good day, I may be able to answer half the questions. Sometimes when my rotation partner and I get grilled together, it really takes the pressure off, even if the other person is just standing there for moral support. Other times, I am give a reprieve and get sent to do some practical things like putting in cannulas in patients’ arms and taking bloods. My fine motor skills are leaps and bounds better than my ability for memory recall. Find a vein in a frail and dehydrated old lady with paper-thin skin big enough for a medium gauge cannula? No problem, I’ll give it a go. List the causes of pleural effusion? Out of the dozens of causes, I’m stuck after listing four. If the career of a physician is predicated on the ability of memorizing long lists, I may have better luck at surgery where manual dexterity counts for something.

Post Mortem

Eight o’clock, my rotation partner and I walk through the green doors. In front of us, the body of an old man is perched on top of a stainless steel cart. Next to the cart is a sink with a spray hose and a stainless steel bench with a cutting board. To the right is a bench with various sharp tools designed to cut through any organic material. The man on the cart died suddenly last week at home. Today the pathologist is going to perform a autopsy and try to find out the cause of death. In Queensland, all autopsies have to be witnessed by the police, so two police officers are also present.

In walks the pathologist. We exchange greetings and he starts working. Wielding a scalpel, he expertly makes an incision from the man’s jawline, down his neck, through the middle of his chest and abdomen, all the way through to the pubis. As he peels back the chest tissues and abdominal wall, the room is immediately permeated with the smell of three days of decomposition, despite the refrigeration. I look around: the smell does not even register with the pathologist, my rotation partner and the police officers start breathing through their mouths. Luckily for me, I am not bothered by the smell. Having peeled back the man’s chest, the pathologist takes a bolt cutter and snaps the ribs one by one until he can lift up the whole front rib cage off the chest like popping the top off a tin can. Next, he frees all the internal organs from the chest and abdominal cavities, slices the tongue from the mouth through the chin, and in one fell swoop, picks up the whole collection of internal organs from tongue to anus and everything in between and lays it down on the bench. The pathologist’s assistant picks up the oscillating saw and goes to town on the skull. In no time, the brain, covered in its fine web of arteries, is presented to the pathologist.

Each organ is weighed, catalogued, sliced, and examined for abnormalities. In the mean time, the pathologist’s assistant sews up the body, leaving a small opening in the abdomen into which he puts a plastic bag. All the chopped up organs are returned to the body into the bag, like so much table scrap being swept down the garbage disposal. The whole procedure is cold and clinical, without any emotional attachment. The person on the table was someone’s father, someone’s husband, someone’s grandfather; but in here, he is just a body whose cause of death the pathologist is trying to determine.

Toward the end of the autopsy, the door to the room swings open. Another body is brought in on a steel cart. “Suicide by hanging,” announces one of the wardies, pointing to the noose still around his neck. The pathologist’s assistant takes the spray hose and cleans off the ants still crawling on the body, then pushes him into the morgue. “We’ll do a post mortem on him later to make sure it was a suicide and not a homicide,” says the pathologist.

With that, the autopsy comes to an end. We thank the pathologist and head to the ward.

Back to the Grind

I am scared.

Today was the first day of the last, and the toughest, rotation this year: internal medicine. Ward round started in the intensive care unit, where I met the consultant I would be attached to for the next four weeks. Immediately, I found myself struggling to answer the questions he threw at me as we saw each patient: chest x-ray interpretation, causes, investigations, and treatments for secondary hypertension, community-acquired pneumonia, and heart failure. Standing in front of the consultant to my left, a senior medical officer (SMO) and a principal house officer (PHO) to my right, I tried to wrestle my brain back from the beaches of Fraser Island as steam started to build up under my collar. It was like playing dodge ball while being chained to a fence post. Two hours later and satisfied that I got a taste of what was to come in the next eight weeks, the consultant left; my battered body sat in a heap on the floor. I picked myself up and finished ward round with the SMO and the PHO.

I finished the day with a long list of things to look up: too much information to learn, too little space in brain.

The Three Amigos

Another break, another walk on Fraser: 110 kilometers, five days, three guys, two camp stoves, and one grand time. The route was similar to the walk I did in July, taking in Lake McKenzie, Lake Wabby, Valley of the Giants, Lake Garawongera, and Seventy Five Mile Beach. It was back to basics: wake up with the sun, have breakfast, pack up, hike, rest with or without a swim in one of the beautiful lakes, hike some more, set up camp, have dinner, go to bed; repeat the next day.

James and Mike on the trail

At Lake Wabby Lookout

James surveys Hammerstone Sandblow and Lake Wabby

My strategically-taped feet enjoying the fine beach of Lake Garawongera

Wild flowers by Lake Garawongera

Walking down Seventy Five Mile Beach under ominous skies

At Rainbow Gorge

Walking out of Kirrar Sandblow

Walking down the beach as the tide recedes

Keen fishermen waiting for a bite

Mike trying to dissuade a dingo from following us

On the late afternoon of day four, after setting up camp at One Tree Rocks Camping Zone on Seventy Five Mile Beach, James and I walked to Lake Wabby, about four kilometers away, for a swim. When we reached Lake Wabby, the sun was starting to dip behind the trees in the west. People were streaming out to head back to their four-wheel-drives. As we were getting ready to jump in for a swim, we noticed someone lying motionless on his back, covered in towels, with a few people standing nervously around. Sensing something was not right, James and I walked up, introduced ourselves, and asked if there was anything wrong. It turned out that Evan from Ireland, like so many visitors to Lake Wabby, ignored the posted warnings and did a dive into the lake. Immediately, he could not move his limbs. He soon recovered movement in his arms and his friends dragged him out of the water. Their tour guide went to get the ambulance while his friends stayed with him. We went up to Evan and quickly did a peripheral nerve examination. Evan had injured his spinal cord at the C6/C7 level from the dive.

Freightened, Evan’s eyes darted around, not sure what was happening to him. Hoping that he would remain stable, we reassured him that the ambulance would come soon and take him to the hospital. As the last bit of daylight faded away, the paramedic arrived and brought the news that a helicopter was called from Brisbane. He quickly examined Evan and expertly put in an IV drip. We stood around and waited impatiently for the helicopter.

At about eight o’clock, we heard the sound of a helicopter approaching, then saw the search light beaming down. Finally! After circling a couple of time, the chopper landed on the massive sand dune next to Lake Wabby. James and I climbed up to the top to check it out. What a sight! The red-tinged bright full moon was hanging low in the sky, casting a surreal glow on the bare sand dune. With the helicopter perched atop a flat section of the dune and the paramedics milling around to get their equipment, the scene was a rescue mission straight out of a movie. How I wish I could capture it with my camera! But the setup would take too long and we needed to get Evan out of here. The paramedics strapped Evan to the stretcher. All of us gave a hand and carried him up the sand dune to the chopper. Whipping up a whirl of sand, the chopper took off to Brisbane.

A goana sunning itself

Reflections off my sunnies

The next day, we spent the afternoon lazing around the fine white-sand beach at Lake McKenzie. And with that, our walk came to and end. Casualty count for me: three subungual hematomas, two fallen-off toenails, three big blisters, four small ones, a sore Achilles’ Tendon, and two sore shoulders. And my inner Masochist says it was all worth it.

Four Down, Six To Go

Another rotation is over! That means another week off. What do I want to do with myself for a whole week?

I could lounge around and do nothing (and be bored to death), I could go to Brisbane (not all that exciting either), I could study ahead of time for the next rotation (yeah right, as if), or I can do what I have really enjoyed doing for break this year. How about going to Fraser Island again? Six days, 100+ kilometers, me and nature. Sounds like a good idea. This time will be even better, because my mates James and Mike from Brisbane are coming up to join me for the walk.

Good times!

Wrapping Up

Where did the rotation go? It feels like I just had exams last week and all of a sudden it's time for end-of-rotation exams again? I guess I shouldn't be complaining; it probably means this GP rotation has been so good that time just flew by.

In the last seven weeks, I have seen more sore throats, coughs, and tonsillitis than I care to count. But it was presentations like hyperthyroidism, management of diabetes-related complications, evaluation and dressing of wounds, and hands-on procedures like cutting out skin lesions and suturing cuts that made the days full of variety; an eight-hour day would be gone before I knew it. The days were definitely more than just about "tears and smears" (tears - depression; smears - Pap smears) that specialists often say disparagingly regarding general practice.

Another aspect of GP I find enjoyable is that GPs, at least the good ones, really do treat the patient and not just the disease. Specialists are like service stations where patients stop to get their problems fixed, but GPs go on the journey with them. Getting to know the patients as people, not just someone anonymous with gallstones or broken wrist you probably will not see again, is what really appeals to me. This rotation was the first rotation in which I had a lot of one-on-one contact with patients. They seemed to like me well enough. And it was reassuring that most patients found me easy to talk to. Some of them even called me "doctor." By now, when the patient says "doctor" at my general direction, I find it a lot easier to suppress the urge to look around to see where the doctor is.

Well, all good things have to come to an end. Now I have to study for exams, the bane of my existence! Why does a rotation so enjoyable have to end this way?

Shamu!

After a week of gray and wet weather, the sky cleared up again today and the weather returned to the normal winter day in Hervey Bay - dry, sunny, and warm. I felt like I was coming down with cabin fever after a week of being indoors - I tried to study but I couldn't sit still and had the attention span of a nat. So I went to the pool and had a swim to get it out of my system.

The Hervey Bay Aquatic Centre, with a 50-meter pool open for the summer and a heated 25-meter pool open year-round, is where I go for a splash every few days. A lot of people consider swimming pretty boring. In a way, I guess it is: all you see is the black line at the bottom of the pool, all you hear is water sloshing around, and you don't get to listen to your tunes during the work out. But that's the appeal for me; it's a sort of sensory deprivation that I find therapeutic. Also, you don't get sweaty as your sweat is constantly being washed off. No music? No problem. I just set my mind free and let it wander. At some point, a soundtrack would come out. I don't pick the tunes, it just plays. Today's soundtrack consisted of the leitmotif of Requiem for a Dream, which morphed into Carmina Burana, which then turned into Santana, and then Branford Marsalis popped up, which carried me through the cooldown lap. See, who needs an iPod when you've already got one built in?

Feeling spent after the 2-km swim, I made myself a protein shake, then started making dinner. I know I am going to sleep like a coma patient tonight.

~~~~~~~~~~

Dinner: simple but tasty stir-fried lamb and broccoli

House of the Setting Sun

I went to a nursing-home visit this evening. It was a high-care facility where all the residents are highly dependent on the nursing staff for even their most basic daily activities like going to the toilet, feeding, and showering.

Walking through the front door, I was immediately surrounded by that characteristic "old folks home smell," a mixture of antiseptic solution, stale air, urine, and the occasional heavy scent of air freshener someone had sprayed in a vain attempt to make the air more breathable. With my olfactory glands quickly and fully saturated and desensitized, I walked with my GP down the hallway starkly lit with fluorescent lights and decorated with generic paintings of flowers. The paint on the wall and the lighting together gave off an eerie green-hued tinge to everything inside.

We went from room to room, visiting the dozen or so residents my GP was responsible for. Some gave a half response to our questions, others were loquacious and intent to chew our ears off. Some had their mental faculties more or less intact and were sitting in the dining room chatting to other residents, others were so demented they were only a shell of their former selves lying in bed completely unaware of their surroundings. Some had pictures of their families and flowers next to their beds, a result of their families trying to make their corners of the rooms as homely as possible. Others seemed not to have anyone left in this world, with the walls and nightstands on their corners of the room completely bare and not a sign of visits by anyone was detectable.

My GP started to review the drug charts. Anti-depressants, sedatives, and stool softeners seemed to be the staples of the elderly population in the nursing home as they are in the community. One by one, the charts are reviewed, the drug dosage adjusted; then the stack of charts are set aside like a pile of freshly-finished homework.

"This place is so depressing." I commented to the nurse.

The nurse chuckled, "Well, it can be depressing. But you get used to it."

For the residents here - some of whom depend on anti-depressants to even get the energy to chew their bland meals, who are on sedatives and kept in a low-stimulus environment so they can sleep their days away and so the overworked nurses would not have to deal with any delirious residents, to whom a 5-minute visit by the doctor once a month may well be their only contact from the outside world other than the nurses - the remainders of their lives are no more than a disorienting drag from one meal to the next in an infantilized existence. The flickering images on TV no longer mean anything; it might as well be showing an alien world on Mars. Are the residents with more or less intact mental faculties thankful for being alive each day, or are they envious of the demented ones who are blissfully ignorant of their terminal predicament?

The visit came to an end. As I walked past the front doors, I took a deep breath of the fresh cool night air. I reminded myself again that I am here as a health care profession (albeit one in training) and despite my personal opinions, these residents are here to stay; all we can do as doctors and nurses are to make their last days as comfortable as possible.

What Am I?

It seems that people sometimes don't quite know what to make of me - Chinese? American? Recent immigrant to Australia?

How about all of the above?

In conversation, sometimes people would ask me,

"Are you a Yank? You sound like one."

or

"Where are you from? You don't sound like you're from around here, by the sound of your accent."

Other times, the conversation would go like this:

"Where are you from?"

"California, but I'd lived in Washington, DC, for seven years before coming to Australia."

"But, where were you born?"

"China."

"Ahh," as if a mystery has been solved and they now know exactly what kind of a person I am.

I've also gotten comments like:

"I didn't think you're American; I thought you got your accent from your parents."

or

"I thought I heard an accent when you speak, but it's not Asian."

or

"You were born in China? But you're so American." (as if they are mutually exclusive.)

Over time, I came to understand that the question "Where are you from?" means one of five things, depending on the person asking the question:

1) Where were you born?

2) Where do you consider home?

3) Where do you go to visit your family?

4) Where have you lived the longest?

5) Where did you grow up?

With me, people are rarely satisfied with the first answer I give. They tend to ask any of the above five questions in different variants until they get the answer to what they really mean.

So, how about this when someone asks me where I am from:

"I was born in China. I lived there until I was fourteen, when my whole family moved to the US. I spent the next fourteen years between California and Washington, DC. I then moved to Brisbane for med school and am planning on staying in Australia afterwards. I consider myself Californian because it feels like home, that's where my family is and that's where I'd spent my formative years when I developed my self-identity. I respect the Chinese tradition of family hierarchy and filial duties, at the same time I embrace the American ideal of individualism but reject the wanton consumerism and materialism; I also identify with the Australian sense of egalitarianism. I'm Chinese; I'm American; and I'm becoming Australian."

I suspect not too many people have the patience to listen to all that as a response to a seemingly simple question.

~~~~~~~~~~

Dinner tonight: pizza with a base of Lebanese bread topped with mozzarella, garlic, artichoke, sundried tomatoes, olives, and fresh coriander, rocket, and basil.

Tonic for Perpetual Health

As part of the GP rotation, I had a visit today to an audiologist, one of the allied health professionals in town. An audiologist does hearing tests, fitting and fine-tuning hearing aids for people with hearing loss.

I sat in on a hearing test on a young man in his mid twenties who had lost most hearing in his right ear after a few years of working in a saw mill with only occasional use of hearing protection. Afterwards, the audiologist took out the file for the next patient.

"This next patient is a very interesting lady. Now, just take off your medicine hat for a minute. Other than needing hearing aid, Mrs. S____ is in exceptional health. She told me her secret on her last visit. There's something she drinks every day to keep her health, and she swears by it. Whatever ails you, diabetes, cancer, high blood pressure, anything, her drink cures it. She gave me a small bottle of it."

Okay, it must be another one of those juice of the month that claims to do everything for you. I waited for him to pull out some exotic juice from a far-away land.

Beaming, he opened a drawer and pulled out a clear bottle with a red label containing some clear fluid. The label proudly declared "Stolichnaya Russian Vodka." "Vodka?" I said incredulously. "Yup." Well, I guess you could call Russian vodka an exotic juice from a far-away land.

The audiologist opened the door. Mrs. S____, an elderly woman walked in and sat down. "Did you drrrink the vodka today?" she asked the audiologist in her thick Russian accent. "No, not today," the audiologist confessed.

Giving him a disapproving look, Mrs. S____ then turned to me and asked, "Do you drrrink?" "Not vodka," I answered. "Why you don't drrrink? It make you strrrong! One cup a day, I drrrink."

After the session, Mrs. S____ turned to me as she walked out the door and said, "Next time, I brrring you some."

Where else but in primary care would patients offer health advice to their doctors?

~~~~~~~~~~

Tonight's dinner: broiled salmon with Chinese five spices on Chinese cabbage and blend of jasmine/brown rice.

GP Land

It's been two weeks since the start of GP rotation and I'm digging it. Coming out of mental health rotation, I am glad to get back into the medical side of medicine. Dr. R., the GP I am following lets me see patients on my own (under his supervision, of course) and do a lot of the procedural work like cutting out skin lesions. Sitting in my own room seeing patients is the perfect way for me to try out this whole GP thing.

One aspect of general practice that appeals to me is that you never know what's going to walk through the door next. One patient could just have a cut that requires suturing, the next patient could come in with four chronic conditions that require full reviews. Another aspect that appeals to me is the continuity of care. When a patient comes in with something that probably requires an operation, you refer them to the surgeon. When they come back later for a follow-up visit, you get to see the patient in recovery and check whether your clinical suspicion was right in the first place.

~~~~~~~~~~

Today a patient came in complaining of bumps on his back that had been there for years. One of them grew bigger and painful over the last week and he was concerned. After taking more history and examining the bumps, the big one being about three centimeters in diameter, I made the diagnosis of sebaceous abcess, or in layman's term, a giant inflamed zit. I called Dr. R. into the room and presented to him my findings. He agreed with my diagnosis and proceeded to explain to the patient that it was not anything bad and the best way was to leave it alone. Standing next to Dr. R., I asked, "In what situation would you decide to drain it?"

He looked at me, as if thinking "ooh, you're going to be sorry you asked." Then said, "We can do an incision and drainage now, do you want to do it?"

Not knowing what I was getting myself into, I said, "Sure!"

Up the patient went onto the procedure table. After I injecting the local anesthetic, Dr. R. explained to me, "Just use the scalpel to lance the abscess, but watch out, it could be under a lot of pressure and the collection of pus could come out with a lot of force." Handing me the scalpel, he said, "You'll know when you've lanced it. You'll smell it. If you need anything, just come get me in my room," then walked out to see the next patient.

I was left holding the scalpel thinking about the giant zit exploding in my face. Gingerly, I positioned myself to be out of the possible trajectory of the pending explosion, then pushed the scalpel down the center of the abscess. No explosion happened. I breathed a sigh of relieve and my nostrils were filled with the sour and acrid smell of pus. Yup, Dr. R. was right. For the next ten minutes, I poked and squeezed the abscess and wiped away the cheesy blood-tinged pus. Finally, having squeezed the last drop of pus from the abscess, I put the scalpel down. Dr. R. walked in, checked my handiwork, and said, "Good job, Tony." Now I knew why he had wanted to leave it alone and let it pop by itself. I asked an innocent question but got the answer the hard way.

Well, it was all part of the learning process. At least the patient felt better right away and did not have to deal with the pressure on his back anymore. Though next time I may want to do it in a place with better ventilation.

~~~~~~~~~~

Tonight's dinner: broiled mackerel in ginger marinade on Chinese cabbage and sweet potatoes.

Solo Strolls

With another set of exams behind me, I was now looking at a nine-day break before the beginning of the next rotation. What could I do with myself for all that time? After the last trip to Fraser Island in May, I was keen to make a return trip. All my friends were either busy or injured or otherwise unwilling to camp in the "winter cold," so this was going to be a solo trip.

The plan: the northern portion of the Fraser Island Great Walk, taking in lakes, forests, and a long walk down the beach.

Total distance covered: 105 km.

Time: seven days.


Day 1: Wanggoolba Creek to Lake McKenzie, 10.8 km

The barge took half an hour to cross the placid strait from River Heads to Wanggoolba Creek on Fraser Island. The sun was just warm enough to cancel out the cool breeze coming from the sea. As soon as the last car drove off the barge, I stepped off the ramp and, with my backpack fully loaded with all my gear and supplies for the next seven days, started the walk.

The first three kilometers were on the sandy four-wheel-drive track. With its loose sand, the road didn't give the walk an easy start. Rounding a bend, I encountered the first animal on the island - a snake. It was just lazily sunning itself on the sandy road warmed by sunlight filtered through the trees, its presence betrayed by its menacing green-and-brown pattern that would have otherwise given it perfect camouflage in the woods. Giving it a wide berth, I gingerly walked past it on the other side of the road, knowing that it was probably poisonous.

Passing a huge sign welcoming visitors to Fraser Island, I followed a sign to the walking trail formed by the fire control line. Leaving the dusty four-wheel-drive road behind, I now entered the forested area of the island. Not a soul was in front or behind me. The only sounds were the trees rustling, birds chirping, and the rhythmic crunch of my boots stepping on dry leaves and branches.

A leisurely two-and-half hours later, I arrived at the familiar fenced Lake McKenzie hikers' camp. After the routine of setting up camp, the rest of the afternoon was devoted to sitting on the white beach of Lake McKenzie, running into the cold water for a quick swim, reading, and watching the advancing shadow cast by the trees as the sun slowly sank in the west.

Night came quickly. After a dinner of cous cous with tuna and peas, tea with dried apricot and figs, I started to do some reading when the sky opened up and a shower swept through the campground. Five minutes later, the rain passed and the half moon was again faintly illuminating the landscape.

I went to the edge of the lake and tried to photograph the lake under the moon. Then I realized what I was trying to do was beyond the technical capability of my camera. I ended up waving my flashlight at the camera with a long exposure; this is the result:

Day 2: Lake McKenzie to Lake Wabby, 11.9 km

I woke up as the sky was brightening up and birds started chirping. Talking to a few other people in the campground, I found out that there were actually three other groups of hikers heading in the same direction. For the next three nights, we would share the same campgrounds.

After breakfast, I wandered around the empty beach of Lake McKenzie. Devoid of the daytrippers that would arrive later on 4WDs and buses, the lake was a serene place. After lingering for an hour, I reluctantly packed up and headed to the trail as the first carload of people arrived.
The trail again weaved through forests of paperbarks and dense undergrowth, the air changed from damp and cool in places with tall trees to dry and warm where sunlight was able to penetrate the thin canopy.
Arriving at the Lake Wabby campground in the early afternoon, I set up my tent and had a quick lunch. Actually, lunch wasn't a meal per se, but a series of snacks as I hiked and rested.
The campground was not next to Lake Wabby, but actually over a kilometer away. I walked down a series of switchbacks to the bottom of the hill then up the Hammerstone sandblow to arrive at Lake Wabby - a small but deep lake being slowly swallowed up by the giant dunes that had created it in the first place. Another quick dip in the chilly water, another lazy afternoon lounging on the slopes of the sand dunes, plus a little bit of reading - I was happy as a clam.
In the middle of the night, I woke to the sound of rain hitting the tent. Reassured that I was dry and warm, I went back to sleep to the soothing white noise that surrounded me.


Day 3: Lake Wabby to Valley of the Giants, 16.1 km

I woke to another bright morning with blue skies and singing birds and had another leisurely morning with breakfast of warm muesli and tea. Then I headed north towards Valley of the Giants.
The trail north of Lake Wabby was supposedly "remote," according to warnings on the map. However, I found that it wasn't anymore so than the previous sections. Perhaps by "remote," they meant that that section of the trail was not as easily accessible by vehicles as were the earlier sections. I kept to my easy pace of covering about four kilometers in an hour. The trees around me started to become taller and taller as I entered the original old-growth forest. The well-marked trail never failed to keep me on course. As I ascended a steep hill via switchbacks, I came upon a sign pointing to Badjala Sandblow six hundred meters down a side trail. Leaning my pack to a tree, I wandered off and climbed up the steep dune to get to the sandblow.
As soon as I summitted the dune, I was hit by the stiff wind from the Pacific Ocean just a few kilometers away to the east. The wind whipped up the sand ever so slightly, carving small ridges on the faces of the dunes and depositing the find grains to the leeward side and, in the process, slowly advancing the dunes to swallow up the vegetation that stood in their way. A few shrubs and grass managed to grow on the dunes and clung on to life defiantly, as if engaging in a constant struggle against the combined forces of the Pacific winds and the mighty sand dunes and attempting to help their brethrens down the slopes.

An hour passed before I was back on the trail to the campground. Arriving at the Valley of the Giants campground almost 5 1/2 hours after setting off from Lake Wabby, I attended to the chores of setting up camp. A 4WD pulled up and down came nine sleeping bags and tents. Someone got out and proceeded to set up tents in four of the seven campsites. As a result, the campground became overbooked and the four groups of us had to share three campsites. I later found out that they were a group of hikers on a walking tour with full car support. The campground was supposed to be reserved for hikers only. Yes, they were a party of hikers, but with car support, is that cheating?

Day 4: Valley of the Giants to Lake Garawongera, 13.4 km

A couple of kilometers from Valley of the Giants, the trail emerged from the forest and led into a much drier landscape of short ferns and palms. Continuing on, the trees became taller again and soon the trail was again flanked and shaded by dense vegetation.

Without a lake to take a dip in the day before, I was starting to get sticky and odorous. Arriving at Lake Garawongera only four hours later, I quickly set up camp, ate another snack, then headed to the lake with my book.
Lake Garawongera, while not as "clean" as Lake McKenzie, look mighty inviting. I jumped into the water for a quick swim. Because of the shallow depth and the sun, the water was very pleasant. I swam around the reeds not far from shore and felt the two days' worth of grime coming off my body.

I sat on the beach, reading and relishing the feeling of being miles away from "civilization," until the sun dipped behind the trees to the west and the nighttime chill set in.

bright red plant that grows on the lake beaches, each no more than an inch in diameter

Day 5: Lake Garawongera to One Tree Rocks Camping Zone, 23.1 km

Today was going to be a long day, with over twenty kilometers on the agenda. I packed, said goodbye to the other hiking parties, who were either staying an extra day at Lake Garawongera or heading off to other places, and got on the trail.

It was an easy one-and-half-hour walk to the resort village of Happy Valley on the eastern shore of the island. Hearing the sounds of the rolling waves, my steps quickened. My plan was to camp at one of the camping zones along the ocean beach tonight where, unlike all the previous campgrounds, water was not available. I filled up both my water bottled and the hydration bladder - adding four-and-half kilos to my pack.

With just another short walk, I came upon the beach stretching to my left and right for as far as the eye could see. Seventy-Five-Mile Beach, which is in fact only fifty-eight miles long but who am I to argue about the name, is a wide stretch of sand covering most of the eastern shore of the island. I turned right and started walking south. Destination: seventeen kilometers down to One Tree Rocks Camping Zone along the beach.

After a kilometer or so, I took off my hiking boots and started to walk barefoot along the water's edge. The compacted sand gave slightly as I walked and the waves lapped at my feet as they lost their energy and rolled back to sea. Tour buses, 4WDs, and trucks zoomed past me as they raced down the beach to their next destination, some peole waved as they passed. One 4WD full of backpackers passed me, stopped, hooked a U turn and drove back towards me. "Wanna jump in?" the girl in the passenger seat yelled out to me. "No thanks, I'm just walking." I said with a smile. She gave me a thumbs up and drove off.

Yidney Rocks just south of Happy Valley

After a stop at Rainbow Gorge to check out the Kirrar Sandblow, I got back on the beach and inched along the line between rolling waves and golden sand. The immensity of the landscape made one lose the sense of scale. What looked like a rock "just over there" actually took over an hour to reach. As the hours wore on, the four-and-half liters of water in my backpack grew heavier and heavier. The beach and low dunes to my right, the ocean to my left, and the coastline in front and behind me looked just the same as when I'd first started at Happy Valley. As the sun started to dip behind the trees and my back and shoulders begged for relieve, my eyes searched the low dunes for the green signs demarcating the next camping zone.

Kirrar Sandblow

I crossed the beach toward a low dune to take a break. Then I heard the rumbling of what sounded like plane engines. Turning around, I saw a small prop-engined plane flying low and directly over me. I was near the stretch of beach that doubled as a landing strip for the next beach resort Eurong. I must be near One Tree Rocks Camping Zone! Sure enough, five minutes down the beach, a sign noted "No camping next 2.6 km," which meant the camping zone was only 2.6 kilometers away. I pressed on and within half an hour came to the sign "One Tree Rocks Camping Zone, next 2.3 km." I dragged myself to the first clearing behind the set of low dunes that served as a buffer to protect campers from direct ocean winds. Seventeen kilometers - how's that for long walks on the beach?


As tired as I was, I had to use the remaining half hour of daylight to set up camp. After dinner, I sat in the open tent to do some reading. With my head down, I heard some rustling sound approaching the tent. Looking up, I saw a small dingo sniffing around - it must have smelled the pouch of tuna I'd opened. I shined my flashlight into its eyes and banged my spoon on the empty mug. It scrambled off. Making sure I had everything inside the tent, I turned in for the night, hoping the dingo was too young to be aggressive.


Throughout the night, I heard footsteps outside the tent.


Day 6: One Tree Rocks Camping Zone to Central Station, 14.6 km

Six o'clock, I woke up, unzipped the tent flap, and saw the rouged sky beyond the beach. Feeling rested and happy that the dingo hadn't chew its way into the tent, I walked out to the beach to watch the sunrise.

Early morning convoy of 4WDs driving down the beach

Early morning rays hitting the ridge of low dunes just this side of the beach

With only half a liter of water in my backpack, I set off down the beach - drinking water taps were just three kilometers away in the beach resort Eurong. At Eurong, I turned west away from the beach, put my boots back on, and got on the trail towards today's destination of Central Station.

Dingo tracks on the beach not far from where I camped

Landing strip

The ubiquitous eucalyptus trees

Central Station is a major stop for people touring Fraser Island. Walking to the campground, I passed groups of tourists coming the other way. A couple of them wrinkled their noses as I brushed past. I must have smelled pretty ripe! Arriving at the campground, I had a good lunch and enjoyed the luxuries on offer such as running water and a hot shower.

I whiled away the rest of the afternoon by sitting among the giant pine trees with my book.


Day 7: Central Station to Wanggoolba Creek, 14.6 km

The last six days had gone by so fast, I felt like I'd just started the walk. Alas, it was time to return to civilization; plus, I was running out of food.

Wanggoolba Creek at its headwaters near Central Station

A grove of paperbark

With only the safety ration in my pack and enough water for the walk, I breezed down the trail. Just three kilometers out of Central Station, I stopped by Basin Lake - the almost circular jewel of a lake - for a break. Then retracing my steps seven days ago, I returned to the mouth of Wanggoolba Creek where the barge sat, waiting for the next trip across the narrow strait.

Basin Lake