Playing House

During a teaching session with one of the pediatricians today, I felt like we were the characters on House.

We saw a thirteen-month-old baby girl who was admitted to the ward yesterday. Through her mother, we learned that the baby had a previous history of Hand, Foot and Mouth Disease, which is a viral infection that happens commonly in children. It ran its course and she got better. Then her mother noticed a rash and diffuse redness in the area covered by the diaper. The mother treated it like a diaper rash. After a couple of days, the baby had not passed any bowel motion and was crying incessantly. The mother thought she had constipation and gave her some enema. The baby opened her bowel but was still unwell. At this point, the mother noticed that one of the baby’s legs was swollen from the hip to ankle and that she was spiking fevers intermittently. The mother finally brought the baby in to the children’s hospital Emergency Department. After having five different doctors taking a history from her, the mother clued in to the fact that the doctors were suspecting a non-accidental injury – i.e., child abuse. After a skeletal survey of the baby turned out normal, more investigations revealed the final diagnosis: the baby had septic arthritis of the hip. Ok, so the diagnosis was not House-worthy, but the process just made me think of the show.

There we were, three med students taking turn asking the mother the history yet again. Each time we were lead down the garden path, only to find that each piece of new information made us do a complete U-turn and think about a different process. Sure, all we did was take the history, we didn’t do any of the crazy things on House like going to the patient’s home and digging up the sandbox (as if doctors really do that in real life). Unlike House, our clinical coach, the pediatrician, was actually very nice to us and to his patients. So maybe it wasn’t like House after all, but I really enjoyed the exercise.

Going into the rotation, I didn’t think I would like pediatrics that much. But I think it’s growing on me.

Baby Check

I enjoy going to the neonatal ward. With all those chubby newborns and happy parents around, you can’t help but smile and share their joy. Yesterday I followed a resident on the ward and did a few well baby checks, which is one of the skills we have to learn during this rotation. Before each newborn is discharged, they are given a once-over by a doctor to make sure they are normal beyond having ten fingers, ten toes, and no obvious deformities.

Like everything else in medicine, there is a system to doing a baby check. You literally go from head to toe and front to back to examine the baby. I especially enjoy doing the primitive reflexes like the grasp reflex in the hands and feet, a telltale sign of our arboreal ancestry, and the Moro reflex, which is believed to be the only unlearned fear in the newborn. Today we had our baby check skills assessed by the neonatal consultant. The way I interacted with the baby I checked must have looked really natural, the consultant asked me afterward if I have kids of my own. Well, besides the four babies I delivered during the O&G rotation, yesterday would have been the first time I handled newborns. So maybe I do have a knack for handling little babies.

In Retrospect: Venice

Not much needs to be said about Venice. Everything about it makes it an attractive destination: the labyrinthine canals, the history behind every building, the festive atmosphere, those gondolas, the colorful houses, even the throngs of tourists. My short trip to Europe with my sister in September 2002 included Venice in the spur-of-the-moment itinerary. Even though we only stayed for two days, the time was well spent getting lost in the backstreets, island-hopping by water-taxi, and filling my daily quota of gelati.

Venice is a collection of islands scatter through the lagoon, with the main island connected to the mainland by a train bridge.

View of San Marco Square from the poor-man’s gondola – the utilitarian water-taxi

San Marco Square was deserted in the early dawn.

At this early hour, the famous and famously annoying pigeons were the only visitors to San Marco Basilica and Campanile.

The gondolas were moored to pylons at the end of San Marco Square with San Giorgio Maggiore Island in the background.

Later in the day, the gondolas would be put into service for all the tourists who wanted that romantic ride through open sewage, er, I mean the canals.

The juxtaposition of gondolas and a warship

The water lapped at the edge of San Marco Square. Flooding has become a common occurrence in recent years due to both the gradual sinking of the city and rising level of the sea.

Gondolas going under the Bridge of Sighs

Get your tschochke along the waterfront

Art student or watercolor master?

While gondola rides are considered a must-do in Venice, we got around by the much more utilitarian water-taxi.

Just a quiet corner in some back canal

All the ubiquitous gondolas were starting to make the whole place feel like a theme-park, only tourists were riding them, after all.

Out on the Island of Burano, the residents must have been competing to see who has the house with the loudest colors.

An American suburban neighborhood association president would surely go apoplectic upon laying eyes on such gross violation of uniformity and the distinct lack of beige.

Filling up on gelato

Donating to a Good Cause

On Monday I had my car towed to a nearby garage. The mechanic called me the next day and broke the bad news. Just as I had suspected, the engine was completely fried. The cost of repair would come to be about the same as what I had paid for the car two years ago. After thinking about my options, I decided to cut my losses. I will probably only get a token amount if I sell it for scraps. So, just like what my parents did with their dead cars years ago, I decided to donate its corpse to charity. A quick Google search landed me on the website of the Cerebral Palsy League. A couple of phone calls later, my car is officially off my hands.

I hope they actually get some money out of it, because I’d like to think that someone with cerebral palsy will benefit, in whatever little amount, from the death of my car.

A Timely Death

This morning, my housemate borrowed my car to go down to the Gold Coast to pick up some of her stuff. In the afternoon, my phone rings. My housemate asks me how long ago I last put oil in my car. A couple of months ago, I guess. Well, the car is now sitting at a service station next to the freeway exit, completely dead.

I borrow a friend’s car and drive down to Coomera where my housemate is stranded with a carload of her stuff. I try starting my car. Wrrrrrrrr, wrrrrrrrr, wrrrrrrr… The starter works in vain, the engine won’t turn over. It sounds like the engine has had it and decided to call it quits today. Like many old cars, my car has been burning oil every since I got in almost two years ago. I have been anticipating its demise, but have been giving it palliative oil changes. It has surprised me by chugging along with no complaints for the last two years. And apparently, today it has decided to go out, not with a bang, just a lot of shakes and black smoke out of the tailpipe.

I help my housemate transfer her stuff to my friend’s car and head back to Brisbane. My disabled car will have to wait until tomorrow to be towed.

Casting My Ballot

Our election is coming up in exactly three weeks. Last year I put in my request for an absentee ballot just a little too late, so this year I made sure to send in my ballot application early. I spent the whole of last evening online looking up the positions of candidates and the details of all the ballot initiatives. This morning I fulfilled my democratic obligations by unceremoniously putting the completed ballot in the mail. I hope it gets there by November 4th.

Wait, does California count absentee ballots if the race is not too close to call?

Kids Emergency

This week I am rostered on at the Emergency Department. Over the last couple of years, I have been slowly developing a liking to emergency medicine. Even though it is not always the adrenaline-pumping full-resuscitation cases with patients bleeding profusely as doctors bark orders while jumping on the patients’ chests as the stretcher races down the hall – in fact, that’s rarely the case – I really like the variety of presentations that’s characteristic of the specialty. So, I really look forward to my week at the children’s emergency department at the hospital.

Today I am on from 3 pm to 9 pm. This being my first day, I am still trying to find my way around the department. The consultants and registrars are incredibly nice to us. I have noticed that all the pediatricians I have met so far have been good teachers and really pleasant to work with. It makes sense: in order to be able to get kids to cooperate, the doctors just have to be pleasant to work effectively. It is hard enough to get kids to cooperate during examinations, a grumpy doctor would basically make that an impossible proposition.

The kids around Brisbane must have had a rough weekend. Late in the afternoon, the waiting room is filled with kids with various injured joints. As a medical student, all I can really do to help out the registrars and residents is by seeing the subacute cases: a sprained ankle, a swollen thumb, a rugby-related knee injury… Before long, it’s nine o’clock – the end of my shift. I have not had dinner, but I don’t even feel hungry. Normally, by this time, my thought would be on nothing but food and I’d be gnawing on my pen already.

“You coming in tomorrow?” the registrar asks me. “Yeah, three to nine again.” “Good, I’ll be on in the evening again. See you then, I’ll get you to do some good work.” With that, I change into my cycling clothes, hop on my bike, and ride down the quiet road toward home.

In Retrospect: Tiger Leaping Gorge

Tiger Leaping Gorge, the name alone evokes images of peril, mystique, and majesty. In early December 2003 when I was traipsing around southwestern China, I made sure to do the three-day hike through the gorge. It is not in a national park, nor is it a “protected area”. It is simply a place where people happen to live in a stunningly beautiful setting. Two main trails runs through the gorge: the low trail was being expanded to accommodate cars and tourist buses, the high trail, well trodden by villagers living in the area, remained the footpath that connects the little villages that cling on to the side of the steep mountain. The villages made it possible for people who had no camping gear to see the place. I hiked with a small backpack, ate and slept at guesthouses run by entrepreneurial villagers who took advantage of the fledgling tourist industry being developed around them.

The gorge, flanked by the Jade Dragon Snow Mountain on one side and the Haba Mountain on the other, is reputed to be among the deepest in the world. The jagged peaks of the mountains drop almost four thousand meters to meet at the bottom, a mere twenty meters apart at the narrowest, squeezing the upper Yangtze River through a series of cascades and rapids. I hiked the relatively short high trail with a few other backpackers, enjoyed the warm Naxi hospitality, and visited the bottom of the gorge where legend had it that a tiger had leapt across to safety while being chased by a hunter.

Tiger Leaping Gorge is located in northern Yunnan Province in southwestern China.

At the western end of the gorge, the upper Yangtze, also known as Jinsha Jiang or the “Golden Sand River”, flows quietly through relatively gentle terrain.

Upon entering the gorge on the High Trail, the jagged peaks of the Jade Dragon Snow Mountain was in view.

The Naxi House was a little guesthouse run by a local Naxi family. The Naxi people are the predominant ethnic minority group living in the area.

Maize and pumpkins being dried for the winter

Even the view from the toilet was spectacular.

Persimmons being dried in the sun

Higher up on the trail, the full length of the Jade Dragon Snow Mountain came into view.



I spent the night at the Tea Horse Guesthouse, where I was greeted by the owner with nuts, snacks, and a bong with locally harvested “herbs.”

The next morning, it took a long time for the sun to rise above the peaks across the gorge.

After breakfast, the incredibly hospitable Naxi Mama sent us off on our hike.

The people carved out terraces and lived off the land.

The trail wound its way around the mountain, veering precariously close to the edge at places.

Taking a break with Inbal, Keeley, and John

The setting sun covered the gorge in a dramatic show of light and shadows.

The daughter of the owner of Sean’s Guesthouse swept the courtyard clean early in the morning.

The peaks of the Haba Mountain towered over the little hamlet at the eastern end of the gorge.

Every inch of arable land had been converted into terrace fields.

The water buffalo took a break as his elderly owner looked on.

The height of the mountains allowed the sun to grace the bottom of the gorge for only a couple of hours a day.

The river roared through the narrowest part of the gorge.

The vista opened up again at the eastern end of the gorge.