Friday, June 27, 2008

A Stimulating Job

The patient, with a metal frame screwed onto his head like a crown, is being pulled out of the CT machine and transferred to the operating theater upstairs. He is about to undergo a radical surgery that holds the promise to control one part of his Parkinson’s Disease.

I am rotating through neurosurgery for two weeks. Besides the standard ward rounds and outpatient clinics, I get to watch in theater as surgeons tinker with that most delicate part of the body – the brain and spinal cord. This patient being wheeled into theater has been suffering from Parkinson’s Disease for twenty years and his worsening tremor has become refractory to medical treatment. The radical surgery, only the fifth to be performed at this hospital, will put electrodes into the part of the brain affected by the disease. The probe is then connected to a “pacemaker for the brain.” When switched on, the patient’s tremor will be dampened to such a degree that he will regain normal function of his hands and arms.

In theater, the surgeons gain access to the patient’s brain by cutting loose a piece of his skull. In order to find the right part of the brain to implant the electrodes, the surgeons need to talk to the patient. So, after all the instruments are in place, the anesthetist brings the patient up from anesthesia. Under an infusion of sedative and analgesia, the patient answers questions from the surgeon, shows his tremor by reaching for an object. One of the surgeons carries a conversation with the patient while another pulls the probe out ever so slightly. With a few slight adjustments of the probe, the patient’s tremor is noticeably reduced. It’s quite a sight: a team of surgeons and nurses surround the patient, whose head, with part of the skull flipped open, is bolted to a metal frame that is attached to the surgical bed. The patient calmly answers questions from the surgeons and obeys all the commands, seemingly oblivious to all the work going on inside his head.

After about six hours, the surgery comes to an end. Soon, the patient will be able to wave a little device in front of his chest to turn on the stimulator and, just like that, his tremor will be stopped. Isn’t that awesome?

Wednesday, June 25, 2008

Job Hunting

Last weekend marked the exact halfway point of this year. We are less than six months from graduating. Everyone is talking about where they are putting their preferences for next year – it’s the Queensland version of The Match.

Queensland Health, the state government agency that runs all the public hospitals, employs all the interns in the state. Anyone graduating from a medical school in Queensland who is an Australian citizen is guaranteed an internship spot in the state. They just have to work out how to distribute the spots throughout the state to those students. It’s a pretty sweet deal for them.

As an international student, I unfortunately am not guaranteed a spot. So, to up my chances of getting a job next year, I decided to apply all over the country. As I filed my last application – to Queensland – the hardest part of the game began: sit back and wait. All the states are announcing the match results at around the same time in late July.

I really don’t care where I end up next year, as long as I get a spot somewhere in the country. I could be staying in Queensland but somewhere up the coast. I could be down in New South Wales, living large in the big smoke. I could be in country Victoria, freezing my ass off in the winter. I could be in South Australia with its famous wineries. Or I could be in Western Australia, chilling out in the vibrant twin cities of Perth and Fremantle.

Ah, the possibilities, the sense of uncertainty. Soon enough, I will have to make a choice that will take me to the next phase of my life; or the choice will have already been made for me. I can’t wait; this is nail-bitingly exciting!

Sunday, June 22, 2008

In Retrospect: Angkor Wat

In December 2005, after finishing my first-year elective in China, I went for a little wander around Southeast Asia. Although it was a bit of a whirlwind trip, I did have a three-day visit to Angkor Wat in Cambodia. The sheer number of temples and pagodas in and around Angkor Wat made for an overwhelming experience; after just half a day, one temple started to blend into the next pagoda. Each with its history and religious significance, the temples could be appreciated at so many levels, whether from the perspective of history, or religion, or art, or even anthropology. Though now a Buddhist temple, Angkor Wat was originally built as a Hindu shrine.


Angkor Wat is located in the northwest of Cambodia seven kilometers north of the modern town of Siem Reap, which means “Siam Defeated” in Khmer.
 


The ubiquitous tuk-tuk takes tourists around Siem Reap.


View of the sunset from top of Bakheng


From the top of Bahkeng, glimpses of Angkor Wat can be had amidst the lush jungle


The west-facing Angkor Wat silhouetted against the morning sky


Busloads of tourists visit Angkor Wat each day


Bas-relief on the western gallery depicting scenes from the Hindu epic the Ramayana


Bas-relief depicting soldiers with shields


Riding on a hot air balloon is one way to see it


Another bas-relief depicting the monkey king


Two locals tending to a shrine in the inner temple


View from top of the inner temple


Children playing around the inner temple


A family rests in the inner temple


Intricate carvings adorn the façade


A saffron-robed monk taking a break


A tour guide waits for his group to return


Statues outside the south gate to Angkor Thom


The crumbling south gate to Angkor Thom


One of the many faces of the Bayon in Angkor Thom


Angkor Thom is the setting for many products in Western popular culture, from video games to novels to movies.


The moss-covered statues and shifted stone blocks add to the eerie feel of the Bayon


The slight smile of the faces on the Bayon is like the Buddhist version of the Mona Lisa.


When walking at the top level of the Bayon, one constantly sees the enigmatic smile of the Bodhisattva from every direction.


The exquisite Banteay Srey, located twenty kilometers north of Angkor, is a must see for anyone in the area.


The unworldly level of sharpness and detail in the artistry of the carving on the Banteay Srey is beautifully preserved.


An artist sketching at Ta Prohm, among the most famous of the temples at Angkor


Tomb Raider, anyone?


The root of a silk cotton tree runs along the gallery of the second enclosure.


Another part of the temple almost completely consumed by the jungle


A monk returning from the morning alms-receiving

Saturday, June 14, 2008

ER, In Reality

Emergency medicine, the branch of medicine soaked in adrenaline, as is so often dramatized on various TV shows, is in reality much more subdued and mundane. With so many patients coming in with little cuts and coughs and general non-emergencies, you’d actually hope for the chaos as depicted in ER. 

So, in search of some excitement, I took up the recommendation by the head nurse and did an overnight shift last night. Friday night is normally referred to as “suture night” due to the hordes of drunken people getting into fights and cutting themselves on various sharp and not-so-sharp objects. And more drunken people also mean more car crashes. So I put on my white coat – medical students are required to wear a white coat in the emergency department so we are easily identified, none of the real doctors wears one. Ironic, isn’t it? – and headed to emergency at 10 p.m. on a Friday night.

“That’s really sad – it’s Friday night and you’re here,” was the first thing the consultant told me as I introduced myself. Okay, so no acknowledgement that a medical student was sacrificing his Friday night in the name of learning. Fine, I am a loser with nothing else better to do than studying on a Friday night. So be it.

The night didn’t hold much promise, as it turned out. Customers trickled in with falls and chest pains that turned out to be nothing major. A couple of category 2 calls to the resuscitation bays were also non-events. Two o’clock rolled around, I stood in front of the list of patients waiting outside, trying to pick one to see. “Cat 2 resus 4,” the overhead speakers crackled. I walked over to the resuscitation bay to investigate. “Eighteen-year-old female was stabbed at a party,” the paramedic announced. While the doctors were assessing her, I volunteered to put in a cannula in the patient’s arm. She was a thin young girl, her veins were probably tiny. I wanted a challenge and see if I could put in a big cannula in a difficult patient. Stabbing victims could lose a lot of blood, so large bore cannulas are often necessary. I flipped her arm over and a big fat vein just stared at me in the face. Ha! Too easy! I grabbed the eighteen-gauge cannula and quickly shoved it into the vein while she was talking to the doctor.

While checking her over for serious bleeds and finding none, the noise of someone screaming obscenities on top of his lungs pierced the hushed air. Five security guards were holding a young man down on the trolley. It turned out that he was one of the patients in the secured unit where prisoners are treated. The doctors on duty turned their attention to him and tried to find out why he was so agitated. They maneuvered him into a room and closed the door. Cursing and the noise of the patient thrashing around easily penetrated the thin walls. After twenty minutes or so, the patient wore himself out and decided to stop.

So that was as close to drama as the emergency department got last night. Maybe I was unlucky to have picked last night to come in, or maybe people in the southside of Brisbane were extra lucky last night. I guess I should be glad that nothing major happened, for the people’s sake.

At around 4:30 a.m., as the emergency department went back to a lull, I was told that I should go home.

Sunday, June 8, 2008

In Retrospect: Jiuzhaigou National Park

The devastating earthquake in Sichuan Province in China last month is a reminder that the province straddles one of the world’s most active quake zones. But precisely due to this geologic activity, the province is home to ranges of soaring mountains and unrivalled natural beauty. I went to Jiuzhaigou National Park in October 2003 during my month-long stay in Sichuan.

The name Jiuzhaigou, pronounced ‘joo-JAI-goh’, means Nine-Village Valley; the nine villages are inhabited by the local Tibetan and Qiang minorities. It is in a notoriously difficult to access part of the province. The bus ride, on roads with thousand-meter drops on one side, was in itself a harrowing experience. The couple of upside-down buses on the side of the road, like tipped over giant turtles, didn’t exactly instill confidence. But the breathtaking scenery was well worth the risk.

Jiuzhaigou is situated in northern Sichuan province.


A stream close to the park entrance


The trees along the stream provided a preview of the fall foliage deep on display inside the park.


As 99.9% of the visitors took the shuttle bus, I had the broad plank walkway all to myself.


The water was so clear, it was difficult to gauge the depth of the pond.


Taking a break next to a little cascading waterfall


A Tibetan village is nestled between the foothills and the creek at the bottom of the valley.


The creek widens into small lakes in parts of the valley.


The turquoise water contrasts against the riot of fall foliage around it.


Another view from the plank walkway. The newly-built road for the shuttle bus is at the opposite side of the creek.


Another gem of a little lake


Nourilang Falls is the signature location of Jiuzhaigou. It’s not particularly tall or wide, but definitely photogenic.


A walkway built at the bottom of the falls allows people to take in the view head-on.


Like the name suggests, Mirror Lake does a perfect reflection of the surrounding mountains.


Five Flower Lake is home to a strange scaleless fish.


Five Color Lake is one of the most popular spots in the park. Its nutrient-rich water supports different types of plants, giving the water different shades of the green-blue spectrum.


Another view of Five Color Lake


A popular photo spot for tourists on the bank of Five Color Lake


Pearl Shoal, with a moss-covered bottom, is part creek, part cascading falls.


Sunlight reflected off the clear water created colorful ripples.


Long Lake is the highest and deepest lake in the valley. The clouds gathering behind the mountain gave it a menacing alpine feel.


A flurry is starting to cover the mountains around Long Lake.