Letter 766: On Finding Out

This biggest misconception about pregnancy, is that it is supposed to be a joyous occasion worthy of commemoration in the form of social media announcement via Facebook/Insta/Twitter, followed by weekly documentation of the growing bump, maternal photo shoots showcasing a grossly distended abdomen, and baby showers. 

Nothing could be further from the truth when, this time last week, I found out I was harbouring a parasite in my uterus. You see, the day I decided to do a urine pregnancy test was the day I had a minor accident on the way to work. I had been abnormally exhausted over the past few weeks to the point where I didn't even realise I'd hit the car in front of me until the car pulled over. It was then that I figured something was amiss. At my most enervated state post-night shifts, never did I lose attention on the road. And the hunger pangs. Oh my god. Yes I'm constantly hungry, but the last few weeks was like I could eat a cow and still swallow the moon. 

So that very evening, I told The Husband to buy some pregnancy test kits on his way home (the hospital kit I tested with returned equivocal, funny that). When two pink lines appeared on the stick, it instantly confirmed my worst nightmare, and I burst into tears for half an hour-- much to the surprise of The Husband because he was notably over the freaking moon at the news. At one point he asked, "Don't you want to have kids?" And I shook my head. And then I cried some more because I felt guilty for being such a horrible person. What the hell kind of mom-to-be says or thinks that??

You see, it's not that I don't like kids. Sure, I probably don't like them as much as I like dogs, but that doesn't mean I won't take care of them (I just have to remember to feed them, damnit!). My biggest concern is the anatomical and physiological changes in pregnancy and labour that I have to go through. Now, this is where everyone says I know too much because I'm a doctor. But for fuck's sake, I can't un-know what I already know right??! 

So here's a list of just some of the problems pregnancy can cause (pregnancy is a disease, I'm telling you this)-- and warning: spoilers ahead for you non-medical people who don't want to know about all the potentially serious +/- life-threatening problems that pregnancy and labour can bring (thanks, anaesthetic primary exams):

Cardiovascular

- physiological anaemia of pregnancy 

- hypercoagulable state (hello, DVT/PE)

- pre-eclampsia/ eclampsia

- amniotic fluid embolism

- post-partum haemorrhage (so, my total blood volume is 2.8L, which means I cannot afford to lose even 1L of blood because that would mean losing about 35% of my total blood volume, which would mean effectively, a Class 3 haemorrhage)

Respiratory

- increased work of breathing 

- potentially difficult airway

- aspiration risk

GI

- increased gastric pressure 

- delayed gastric emptying

- 3rd or 4th degree tearing potentially requiring a colostomy bag (sometimes for life)

Endocrine

- gestational diabetes

OK, you see where I'm going with this? "Shock" isn't how I'd describe my feelings when I had a positive urine pregnancy test. It was more sadness, anger, frustration, trepedition, and a feeling of hopelessness, because there was nothing I could do now. Never in those moments of mixed emotions that joy or happiness surfaced. Even till now, when shit got even more real looking at my bHCG levels and my dating scan with a gestational sac, that I haven't really been able to feel any elation at all. On the contrary, I have been irritable and teary. I've been told this is due to the mood swings one feels in the first trimester, but really, if my mood swings are this bad, I shudder to think what I'll be like post-partum. (The fact that I did the ECT list yesterday and had a patient who was 5-months post-partum come in for a titration really makes me nervous.)

The few close friends I broke the news to have been fantastic, especially my crazy-ass study group who managed to make me laugh out loud over our group chat. And for these bunch of people whom I've messaged and/or talked to in person over the past week, I thank my lucky stars they're so supportive. I've also had the support of my bosses and colleagues in the know, and among the culture of career women, I am somewhat relieved to hear that not everyone had felt happy when they found out they were pregnant. There's a lot of sacrifices to be made, and for us in medicine who have come such a long way after sacrificing our youth, social life, family, relationships, hobbies and interests just to make it as a specialist, now it's time to sacrifice your career just so that you could look after your child. Life is resolutely unfair.

There's a culture of avoiding pregnancy announcements until after the first 3 months (at least among the Asians I know), but you know what? I'm telling you now because a) I've always worn my heart on my sleeve and there's no way I could muster a smile when people come up with their congratulatory messages, so I might as well let you know how I feel, and b) the risk of miscarriage is highest in the first trimester anyway regardless of whether one adheres to the superstitious belief of keeping mum (haha see what I did there?) during this period, and c) I am hoping to normalise the feeling of anything but joy at the news of being pregnant. Like I said, the biggest misconception about pregnancy is that it is supposed to be a happy occasion. Well. It is quite normal to feel anything but. So now I know. And in the future, when someone tells me they're pregnant, I would actually ask them how they're feeling rather than offer my congratulations first up. 

Letter 765: Buggah

I'm sitting in bed in Room 19, with an East-facing window looking out to a sliver of blue lake sheltered by soldiers of pine and eucalyptus and other native trees which I cannot identify. It is 1.30 on a Monday afternoon, and I've just finished my ordered lunch of consomme, Irish stew and vanilla custard. Well, I finished as much as I could tolerate. My appetite is coming back, and as much as I'd like to, I still can't wolf down a 3-course lunch. I did finish the peas though.

Never in my life have I been so sick to the point where I needed to be admitted to hospital as an in-patient. We all know doctors make the worst patients, and that we hate even going to see a GP-- much less getting oneself admitted. Oh, nothing a little fluids and bed rest won't cure, we'd tell ourselves, because that's what we'd tell our patients. Don't worry I'll be fine to work, we'd tell our bosses through a voice unrecognisable as one's own. We are relatively young and fit, so we compensate well until the very moment it is pointed out to us that we've been functioning with a temperature well over 39C and a heart rate of way over 100 for far too many days before treatment. And then you look at your own x-rays and listen to your own chest and talk to your specialist physician friends and, somewhat reluctantly-- even putting up a futile argument with your better half-- you agree to go to the hospital.

Let yourself be looked after, reminded Tanya, my old pal and your friendly receptionist at the clinic where I used to work as a country GP. So that's what I did for the last 3 days since stepping foot into Room 19 with a view: I let myself be looked after. Not that I could've done much anyway. I was breathless talking to the physician. Effing NYHA Class 4 (inside joke-- nevermind). Hubby came and sat by me most of the time, and filled my Thermos with water whenever supply ran low. The first night I was in hospital, my dog apparently didn't even eat his dinner and just wallowed in bed. I think he knew that something was wrong with me. I like dogs. They're so intuitive. 

So now, after 48 hours of IV antibiotics, I'm feeling a little better. Still not 100%, and may never be 100% for awhile, but at least, if all remains stable, I can finally, finally go home. 

Letter 764: Daffodils in the Sun

This morning, I woke up to news of a med school classmate taking her own life. She is the 3rd doctor I know in my 10 years of being one to have taken their own lives. All 3 people bade farewell to this world at some point in the last 5 years-- one was another classmate and a fellow anaesthetic trainee, one was another anaesthetic colleague, and now her, a paediatrician. 

I'm ok, but not ok. While I am saddened and shocked by this news, I am also deeply worried about the state of our collective mental health (and by "our", I mean doctors). Physician suicide is not uncommonly heard of in our field of work. In the US, one doctor dies at their own hands every day. We have an alarmingly high rate of suicide compared to other professions, and we already know that certain specialties like acute care (critical care, anaesthesiology, emergency medicine) have a higher rate of suicide compared to other specialties. We know we are at risk of burnout, depression and substance abuse. With our medical knowledge and access to drugs, we know how to best optimise our chances of dying successfully-- sometimes painlessly and peacefully. What we-- or at least I-- don't know, is how to help our peers avoid jumping over the cliff. 

Doctors are a curious bunch. We have that Jekyll and Hyde personality whereby on the one hand, we are kind, compassionate, empathic human beings who care earnestly about our patients. On the other hand, we are high functioning neurotics who can be egotistical, narcissistic and imperious. It is not surprising that if and when we do spiral down the dark tunnel of depression and anxiety, we don't let on to anyone about our state of being. We don our scrubs or white coats, hang our stethoscopes around our neck, and soldier on, extending an arm of reassurance to a patient about to have surgery for the first time, or assuming the role of team leader and directing orders to the team during a trauma call. We put everything on the back burner for the sake of medicine-- our relationships, our social life, our hobbies, and even our physical and mental health. There is a certain stigma and shame attached to doctors calling out for help. It is no wonder we are at risk of breaking down. 

There are multiple reasons why people-- including doctors-- take their own lives, and as the dead take their answers to their graves, we will never know in its entirety our questions of why. I spoke to someone I know who previously attempted, and she said it's not what we all think-- that at the moment just before leaving, everything feels right.

I can only hope that my peers would do the right thing-- whatever it may mean for them.   

Rest in peace, my friend. 

Letter 763: Various States of Happiness

It started out an evening filled with homemade burgers, lamb skewers, and a bucket of KFC, but as the night dragged on, after various bottles of beer and refills of gin and tonic (gin and ginger ale is also surprisingly good too), chaos descended as a shot of tequila was plonked in front of everyone.

It was half an hour to midnight. Half an hour to welcoming a new year. Half an hour to remember all the resolutions we hoped to keep, but with our booze-filled brains, nobody even cared to remember anything at all. In fact, when we were telling each other about what we would be doing if we weren't working as a doctor/pharmacist/accountant/engineer/administrator, I had forgotten my answer from many years ago: travelling the world and doing freelance photography and writing. I said, this time, I would like to be a tai-tai. Lady of leisure. To which Timo cheekily quipped, "Prostitute!" (So very Timo.) 

I guess a lot of the time, our subconscious drives our outlook to life. I was young, energetic, post-internship, eager to explore life at the start of 2010-- of course I wanted to travel the world and write and take nice pictures. Now, after years of toiling in the wards/clinics/theaters, and having completed two fellowships and taking numerous exams along the way, I feel like being a lady of leisure is the way to go. Undoubtedly, I still want to travel the world, but I want to do it in a more relaxed manner. None of my younger travel habits of attempting to squeeze 10 activities in one day.

Quarter to midnight, and another shot of tequila was handed out to everyone. The last time I took tequila shots was in medical school, and I never liked it. This time, I still didn't like it, but the burn down the throat was more bearable. Perhaps it was helped by prior doses of alcohol priming the system. Or perhaps it was in the company of good friends-- some I've known since uni days, and others I met that evening. 

The nature of human relationships is one that will never cease to fascinate me. Some people just tend to click and hit it off, and others don't. The alcohol may have helped a bit, but it was gut feeling that said it's ok, you're safe with these people. So when fits of giggles erupted-- unstoppable, unshakeable, unsinkable-- I knew that it would be fine with the people around me that night. When the clock struck 12 and we all gathered at the balcony to watch the fireworks light up the night sky in strokes of neon brightness, I knew it would be fine to have a few sips of champagne. When we sauntered back indoors and lay on the couch and the guys got out their guitars and strummed to Hotel California and Oasis/Cranberries/Radiohead and all the songs we grew up listening to, I knew it would be fine to join in their terrible singing because nobody could carry a tune nor remember the lyrics properly (especially when we tried Despacito and La Bamba). I knew it would be fine because I had my husband and my friends who are like family to me.

But I don't know if 2018 would be fine. I'm moving across state lines again this year, starting a new job, and preparing for another one in 2019. There's so much to do, and it seems I have all year, but so little time. 

Letter 762: Flights of Fancy

There's a storm happening right now, at 4 in the afternoon, and it is so refreshingly warm and humid and delightful in this summer that has been way too hot and aggravatingly torrid.

December is a month where I churn out some reflective posts, kind of like the Queen's annual Christmas address, and it almost didn't happen this year because I've been away on my long overdue recreational leave, and then delved straight back into work, fitting in jet lag at the same time. It is bloody exhausting, but I'd do it all over again, because my three weeks away from work spent with my family was the best. 

A few updates since my last post (crap it's been so long):

- I passed my fellowship exams at the end of October. Phew! Big weight off the shoulder. Hopefully no more exams after this! 

- Dived back into work after the exams because I don't know why I didn't plan on taking a holiday straight after. 

- Got an email from HR saying I had way too much leave and that I either take it or lose it. 

- Booked myself off for 3 weeks and bought a ticket to Europe. 

- Convinced my parents to come to Europe with me (my dad absolutely detests long-haul flights) because I wanted to do something nice for them, and what's nicer than not having to spend a dime in Europe?

- Stayed with my cousin in Delft and tried to avoid being scratched by Martee his maniacal rescue cat.

- Decided that Delft is prettier and much nicer than Amsterdam, which is a city so convoluted in design that I kept getting lost within its narrow alleyways and circumventricular canals.

- Had the cheapest and best fish and chips at the Delft markets for 2 euros a fillet. Hands-down way better than any fish and chips in London.

- Mistakenly got on the first class train carriage with my second class travel card from Delft to Amsterdam, and miraculously escaped ticket officer spot-checks on board.

- Did not smoke any weed or ate any hash brownies in Amsterdam. I know. 

- Had the best Indonesian food in Delft and it was so good we went back there for the 2nd and 3rd time. 

- Took a day trip to Brussels with my aunt and uncle and nearly froze my fingers off trying to take pictures of the magnificent Grand Place.

- Nearly, very nearly, missed our train to Paris because of the aforementioned cat. 

- Never once had a bad meal in Paris. My god the food! I could rave about it for aeons.

- Bought my weight's worth of macarons from Pierre Herme and ate it for the next 3 days. 

- Took too many pictures of Avenue Montaigne and the Champs-Elysees at night. It was almost Christmas and Paris was just lighted up so beautifully.

- Surprised myself by actually falling in love with Paris (I didn't think I would because Paris has always been slightly overrated). The food, the architecture, the casual grace of Parisiennes, the filthy metro steeped with piss and history... There is so much to live for in this city.

- Surprised myself by not actually buying anything in Paris. My husband was immensely pleased. Not to mentioned hugely relieved.

- Saw snow in London for the first time. It was a Sunday morning and my mom woke me up at 8 to tell me it was snowing. I now see why people get excited at the sight of snow, because it was so mesmerising to see flakes of white fall from the sky. 

- Ate too much Indian food in London. Seriously good. Seriously spicy. I highly recommend a combination of Rajdoot and Deliveroo on a chilly winter's night.

- Not impressed with Harrod's. Selfridges was way better.

- Spent a whole day at the British Museum. Coolest museum ever.

- Decided that London is really only good for 3 things: Shopping, British Museum, and Indian food. 

- Didn't really like the hugely overpopulated city that is London, where you couldn't walk 3 steps without bumping into another human being.

- Bought too many books and not enough bags or shoes (none, in fact) in my 3 weeks in Europe. I KNOW. Surprise, surprise.

- Ate too much food and took too many pictures on my iPhone 8 Plus. Lugged my DSLR around in vain because I never once needed to use it. 

- Upgraded to business class when I flew back to Australia and the bed was better than my makeshift bed on night shift.

- Went back to work 10-hour shifts a day after I flew back and regretted picking up extra shifts on my days off.

So here I am now, filling in the days between Christmas and New Year's, lots of paperwork to catch up on, yet not really wanting to do anything. It's the inertia of tepid, languid afternoons where the lure of a nap beckons. And maybe I should succumb to it. After all, I rarely get restful afternoons like this.

For those who are still taking a peek at this space every now and then, I hope you had a wonderful Christmas. Stay safe, and warm wishes for the new year.