Fuck you long distance.

I sat on this railway hating the fleeting shape of my identity wondering if I care too much for too many things – the most likely candidate being that those close to me influence me much too much.

Maybe if this had been a hug between my parents on the day I left Korea I’d still be with her…. probably.

It’s been a couple of weeks since the breakup, a month since I realized that I saw the future of my relationship go in the opposite directions as her’s. I lost the desire to make an effort to close the gap and with it lost the chance of a compromise. I told her my truth, she cried and two weeks later broke up with me, again with tears; such a sweet girl that I could no longer keep my promises to.

I’m sorry.

That’s the end. Now let’s begin.

This ID has had me ninja into a surgery to remove a tumor on the tongue. Too bad I didn’t have the ID with me at the time, nor did I introduce myself to anyone in the surgery room. After about a minute of me immersed in observing the surgery, the anesthesiologist turned towards me and basically said “Who the fuck are you and what are you doing in my OR?” I might as well have walked in on his family dinner, sat down uninvited, and started hitting on his wife.

Fair enough, glad I got this screw up out of the way  before I started the surgery run. For fourth year med student, our year is divided into four quarters with a random draw to see whether your doing surgery, medicine, GP or psychological medicine. I am currently on the GP run, and that’s why I still have time to feel the soapy sadness that I wrote all about up there.

I love the trust that my GP has given me, these ID cards are so magical that I flashed it to my GP, and by the third patient I had ever seen, I was in a room alone with them taking care of  their health. It was just a repeat prescription, but I fucking repeated that prescription like there was no tomorrow, well actually I couldn’t so we sat there and talked about our lives until the doctor came in and sorted out the prescription in about 2 minutes. What could I do more in that situation? I just smiled and said

“See you.”

I cried watching Cloudy with a chance of meatballs. It’s an animated comedy film aimed at a family audience much like The Incredibles. To make the context more ridiculous is that the scene was a comical moment when the technophobe father of the protagonist drags his mouse literally across the computer screen trying to drag a file to be an e-mail attachment. The tears weren’t lamenting tears at this attempt humor, but tears of sincere sadness. This is from a guy who smiled saying goodbye to both my parents at the airport earlier, knowing that I won’t be seeing them again in a year. I maintained the smile as they walked off in the opposite direction of each other, most likely to not see each other again in a year. I wasn’t being benevolent hiding my sadness with a smile so that my parents won’t see my grief and be afflicted with it themselves, I really wasn’t sad at that moment in time.

Most of you are familiar with the five stages of grief, it’s become as big a cliche as when a girl says “you’re a really nice guy, but….” really just rephrasing “you’re really a douchebag, so…”. The five stages of grief in sequence are denial -> anger -> bargaining -> depression-> acceptance.  The only thing wrong with this model is it almost NEVER happens like this. I have made a slight model to make a more accurate modified version of this model. Which really brings us back to square one of, people are unpredictable as hell when they are grieving about something and can feel any of these feelings at any point.

I can’t even make a legible model that would be personally correct. But, almost always, there will be a delay or a period of ambivalence. From little things such as failing a test, which at the time of getting the test results I couldn’t care enough to say ‘meh’, it’ll hit suddenly – such as on the way home I’d smell the semen tree (how the fuck does a tree smell like sperm? what a fail of nature) and this faint link to failure will have me beat up my brain at its lapse in concentration (note how it never pops into my head that I’m not smart enough – because that’s just bullshit.) This occurs at a larger scale, such as above or the time someone I dearly love told me they had attempted suicide three times at which moment I was all ‘meh’ and they appropriately looked at me like I was a careless asshole. Then a day later, as I was reading a book there was a word cut off as it had reached the end of the line to be read ’su-’. This set off an emotional outflow as I finally realized that this person was undergoing an indescribable suffering far beyond their ability to cope that I had completely neglected, and that this person had been so close to being dead at their own very hands – out of everyone’s lives. In retrospect, it was a completely inappropriate reminder as the complete word was actually sushi and the sentence leading to the word was something about how the person was salivating at the thought of, or looking to enjoy.

Just got back from this place.

Take a simple three seconds to guess where it is…. 3…. 2…. 1….

Now focus your eyes to the left on the person with the orange slippers. What your seeing are the pants of a patient, and this photo is one of the hospital.  This is the kind of hospital some lucky buggers get to work in, I say that with a grain of salt because I hated the general work atmosphere of the doctors here, but at least they don’t have to work in a place like this..

It’s so futuristic, the cranes over here work horizontally. (Legit photo – you can glimpse  Hayward Hall on the left which is where I lived during my first year).

Before I get side-tracked, let me continue on with the hospital. In case you feel bloated in the restaurants, there’s a park for you to take a jog in.

Fantastic.

Now for the part that looks like a hospital in this Korean hospital.

You need special permission to see the yellow people. I don’t mean that in a racist, you yellow Asian ching chong fucker! way. Literally yellow because of the poor liver function and failure to clear something called bilirubin (which happens to be yellow) from the body.

Now, my here’s a photo of my ex..

Hallway corridor which I walked a hundred times.

Plus for those waiting to see a photo of a liver donor’s scar, here it is – embossed upon a manly abdomen.

You even get a free pass at looking at my MRIs on the computer screen, and one of the liver transplant surgeons at the hospital. This will be the  only time you’ll see my abdomen, this pose is inappropriately wtf in every setting except the hospital where I got the scar from.

University of Otago needed to out-do last year. For what they had in 2008 in terms of releasing end of year results, they felt the need to ditch it like a rapist with his used condom.

At least in 2008, they had the decency to tell us when our  results came out. This year you needed to have ‘caught up with the news’. What fucking news? Was it announced in the NZ Herald that the third year results were out? They’re too busy telling people of the serial rapist who after raping multiple women since he was 16, was put into jail, raped his cellmate – then was given parole after seven years. Now he’s raping  again (GASP!) and the police are looking for him.

Not since my health science days, have I looked at PIMS (where our results are released) everyday after the end of year exams. Exam results matter so much less, where 50% and specials (in case you fail) try their best to get you to the year-after- which unless you gym the day before til 2 a.m. the day before the exam, read a magazine for 2 hours and a half in a three hour exam – is usually enough.

Our ‘detailed’ results – as in something more than the single word “Pass” or “Fail” will hopefully improve from 2008. When it came out a month before the next end of year exams – in September. Does it really have to take 10 months to mark less than 300 papers? My neighbour’s left nut could’ve marked it in half the time – and it hasn’t even fully descended yet.

Here’s the first photo I took with my DSLR.

The man of the hour, the man who gave me the camera, the man whose family jewels led to yours truly, and the man who has a part of me making his albumin amongst other things. Look at him, humbly scratching his back while being a little embarrassed at my euphoric high from the present.

I serendipitously chanced upon a solution to my writing flaws. For what I lack in my writing – lack of humor, wit, character, creativity, imagination – just about everything – photos can make up for it, especially as I’ll be visiting the hospital of my surgery soon. You can look for yourselves to seeing the shopping mall in the hospital’s basement and maybe even my scar-ridden abdomen.

I have only two new year’s resolutions. Both relate to the Otago Medical School (well there’s a rarity). First being finishing the summer studentship with gusto and effort. I want the University of Otago to be happy with investing $5000 over the summer holidays so I could research CPRs in the hospice. (Paradoxical huh? Bringing people back from the dead in a place where people go to die.)

Back in 2008, I went into my then supervisor’s office one day for a meeting and asked that we keep this meeting short.
“Why’s that?”
“Oh, you know, I have a flight in an hour going to South Korea for the rest of my holidays”
-Look of utter WTF on the supervisor’s face-
Only time I saw an expression of this magnitude was when I handed in a half decent project at the end.

This year, things have been different. My supervisor knew from the start I’ll be going to Korea, and our good-byes were surprising because my supervisor was admitted into ER the previous day as opposed to my fatherbeing admitted to ER in 2008 which caused me to fly to Korea much sooner than expected.

My second resolution is to start a student’s association to give free tutorials and mentoring to health science students. It’s still in it’s foetal stages (as in not even in it’s baby stages) but hopefully it’ll be ready when March rolls around. My inbox has been modestly filled and 90% of it are from to-be health science students wondering what the hell they should do next year. It’s the same mindset down in Otago, just as it was the same for me. ‘Give me some fucking help’. I will try and fucking help – with a lot of help from my friends.

I was hit with an overdose of lethargy over the course of this year. For so much of this year…. let me just give you an excerpt from a draft that I never published because … well it’s painfully obvious below.

“I’ve  been sitting in front of my laptop since 2 p.m., minus the time for cooking and eating dinner, that’s a solid 10 hours I’ve devoted my day to to be in the perfect place to start some studying.  Instead, I have indulged in everything else you could do by yourself in a room: stare at neighbours,  stare at my wall, stare back at my neighbours being noisy and use it as an excuse to zone out to my own music, facebook, MSN, read up on the latest sporting news, games, watching TV shows then just as I was about to finish with my procrastination, I decided that I should watch House as my ’studying’.

What’s even more amazing is that I had first started this post at the beginning of April… It’s 3 days from June, and so little has changed. I can’t say nothing, as something must’ve changed to prompt me to finish this piece that’s been in draft form for 2 months straight.”

Caught in a self-sprung trap, I felt inadequacy without study. I had mistakenly let the hours of study I did during the day to determine the worth of my life. In retrospect, I should’ve picked anything but, I mean, I showered for a longer time than I studied. It defies logic that the awful feeling at the end of a fruitless day wasn’t enough to make me change the day after, but the world of movies, music, games and friends was too easy to be completely immersed in during the day, and it took until the end of the day for me to feel that familiar sinking feeling of throwing my hours away. A real problem of having too many hobbies is that when I feel that I’ve spent way too much doing one, I can too easily switch onto doing another. During this change, the variability had my mind never feeling a deficit, a deficit that would’ve had me studying.

For some of you, at first glance there seems nothing wrong with the previous paragraph. For most of you, you’d immediately see how flawed my paradigm was, it took me a good seven months.

Our microbiology lab is placed deep into the main campus. The path to the micro lab took me past the buildings that were so significant in my first year at University of Otago as a a First Year Health Science student. I saw a kid stumble out of the main lecture theater of the past, St. David, his steps uncertain and a look of disorientated awe on his face. It was tempting to look down on this guy, with all of that behind me, but the truth is, I felt envious of him.

The first of year of University is filled with so many firsts after being thrust into a situation that is so different than being at high school. He still has the priceless feelings that’ll be fiercely strong with the uncertainty of doing something for the very first time,  just “like a virgin.” As much as I love being experienced and being more confident in the myriad of things I’ve come to know at University, sometimes I miss how much excitement I used to feel at doing the exact same things.

Perhaps I’ve been prone to thinking this way having just reached half way to forty. Being in this double decade life, realistically I’ve already lived a quarter or a fifth of my life. It really made me think about what I’ve accomplished and how I would have spent the days differently knowing what I do now. After about 10 minutes of thinking about my life in such a depressing way during my birthday after the birthday song at  12pm, I looked around my room filled with my closest friends and just felt…. lucky. I may have some ugly parts of my life, but seeing this beautiful part of my life was more than enough than to put a huge smile on my face.

It’s making me think how my life seems so dictative by the people around me.

It sucks I’ve been away from blogging for as long as a month, I put the blame solely on Dunedin. There’s something about this rainy city that takes a perfectly happy single man and plunges him into a dark hole of loneliness. My life on paper has the perfect formula for happiness; Living with my 4 best friends + ability to skip any classes I see fit + 2nd best house in North Dunedin (really) + only a slight financial choke hold + freedom + etc. etc. yet there’s a part of me that feels a mega void, and it just happens to be too big to ignore. Most of my time awake, is filled jumping from one person to another, substituting them for my significant other.

Maybe it’s because within a week I feel that I’ve lost my best friend and a girl. My flaws have been so highlighted through this loss, I can’t even fake false pride to live up to the domain name. (In case you missed it, our domain name is a pun, playing on the word vein and vain). Being disgusted with myself, I’ve dedicated the last 10 minutes to think about this and have managed to finger the reason- I need someone who will always put me as number one whether it be when they want/need someone, or whether I want/need someone (I can handle being a close second to themselves). That just disgusts me more, being so ….. dependent. It’s ironic, because I thrive off being depended on, yet I need them to depend me more so than their need to depend on someone.

Now I know what my problem is, a sane person would say that I should change it. But, I’m not going to, rather I’m going to enhance it. This is a priceless characteristic to have as a doctor. In the hospital, I am in the privileged position to become the lone person that the patient puts their life trust behind. So what that I get addicted to their need for me, it’s not such a bad thought thinking that patients will eventually become the equivalent to my injections of heroine.

It’s 11:45p.m., and this time feels perfect to find the lost friend that I had forementioned. The story of my loss is unfinished so not appropriate to the public eye, maybe the story will become complete tonight – in which case you’ll see another blog post of something worthy of a soapy drama in an hours time.

“Here, hold it, see how it feels.”

My hands were steady as the surgeon’s as my gloved hands took the scalpel where a slow ooze of the blood from the blade made itself down to my fingers. I was captivated by this man’s blood on my hands, lost in an unorthodox mixture of amazement and grotesque in my head. The resident surgeon looked at me with curious eyes, when just a moment ago I was looking at him with the same curiosity to try and understand what was going on behind his, wondering if it would’ve been the same as 2 weeks ago when he would’ve sliced me open.

“So?”

A flurry of stupendous blinks were all I could conjure up. I’ve been awake since 5 a.m. to get to the hospital by 7a.m. to observe everything about a liver transplant. The first surgeon I met was the resident (note: not the resident who handed me the scalpel)  who had admitted to not leaving the hospital for days at a time. Today seemed no exception, as his ruffled hair and barely open eyes were signs of someone who had just woken up from sleeping in some cold corner of this hospital. His eyes widened with shock as he saw me eagerly sitting and waiting in the preparation room. It quickly narrowed into a smile as he connected the dots and remembered that I had been given permission to observe a liver transplant by the head surgeon whilst I was in ICU. (What better time to ask a surgeon a favor?)

After a series of the introductions, I held up both my recently washed hands. A nurse draped a surgeon coat around the front, and prepared two gloves for me. I felt an unreasoned surge of power and could barely hold an urge to initiate the surgery… no, more like murder if I really did start cutting. The patient lay naked in front of me, fresh from having a tube inserted up his penis. I could feel a wince in my loins followed by the origination of momentary pure self-hatred of one body part to another. During the preparation of this patient, I felt connected with him. Everything done to the man formed itself into a phantom pain to my own body. The needle stabs into  the neck, shoving of tubes down the mouth, oranging of the body with iodine and of course the penis tube, all of it all made the same body part tingle.

Then the intern draped blue blankets all over this man’s body except his abdomen. I felt my connection with the man start to break and the surgery becoming what it is, the treatment of a disease or injury by operative procedures, not a reenactment of a personal experience. This time, I was the one holding the scalpel. Ah yes, the scalpel, the resident had a question for me that so far I’ve only blinked to answer.

“Uhhhh……” was how I showed the resident I was an up and coming med student, quick on my feet. The resident laughed at how speechless I was, instructed me to hand the scalpel to a nurse, as he picked up some high frequency vibrating knife that burned the flesh, cutting it with ease.  Smoke from this man filled up the room (I exaggerate) leaving a distinct smell of burnt meat with a hint of human in my nose. From the smoke, a prick rolled into the room, the lead surgeon for this man.

The atmosphere of the room completely changed. The previously joking resident greeted the surgeon with a solemn hello following it with silence. The intern and nurses shifted uncomfortably, with their eyes downcast, not wanting to catch an awkward glance. The surgery clearly belonged to this man, and depending on what he wanted and how he felt, the surgery will follow suit. For the next 7 hours, if he made a joke everyone would laugh, if he told someone to shut the hell up – everyone would, if he felt like a smoke he would leave the room with the patient’s abdomen spread open, if he swore at the particular difficulties of the surgery – everyone agreed, and if he wanted something done – it got done. Before the surgery, I had asked the resident surgeon how long he had been doing surgery for. “Surgery? What I do isn’t surgery, I just stand-by and help.” I get what he means now.

With the surgery in full swing, this man’s abdomen was spread open by mechanical vices on each side revealing everything inside – an anatomical wonder that was so … alive. Everything responded to the surgeon’s incisions with a fresh squirt of blood and even the organs that were left alone made their presence felt, especially the heart that consistently beat upon the surgeon’s hands via the diaphragm. Lost in the inner anatomy of this person, it’s easy to forget there’s anything beyond it – not once did I think about the patient’s face, his expressions of emotions, his personality or his worried family members.

Who would you want doing your surgery? Someone who is completely distanced and mechanically approaches your body, or someone completely attached to you and heartedly deals with the consequence of each cut and the pressure of the possibility at each corner?

While I was dealing with a million thoughts, the intern doctor – whose job did not extend beyond holding things – found the boredom of the job greater than the value of the patient and started dozing off. First to go were his eyes, his blinks becoming longer and longer until his neck joins in and brings his head into a droop. I watched him with fascination, finding watching him with disapproval was followed by a pang of guilt. Every morning, my lectures start at 9, and almost every morning I would sleep a further hour in the comfortable seats of CQ lecture theatre. The stakes may be infinitely higher here, but the principle was essentially the same. Every bit of knowledge would make us better doctors but the repetition can eventually whittle anything mundane which coupled with sleep deprivation sends us to sleep.

“Hey, pull tighter…. I said pull tighter.” The lead surgeon looked up at the lack of tightness, “Fuck, are you serious? Your actually sleeping? Wake up you idiot.” The intern apologized profusely promising his full attention for the rest of the surgery. The rest of the surgery, if simplified, went more or less like this (most of this was explained in English by an observing doctor on a transfer programme to the hospital). Cholecystectomy (removal of the gall bladder, anything -ectomy means to cut/remove), followed by a hepatoduodenal ligament dissection, then after determining where to cut the bile duct with a radioactive marker, the actual cutting of the liver (hepatectomy). Associated arteries / veins and ducts are all sliced then tied up (suture ligitation).

When the liver is ready for removal, the donor plays the waiting game. Across the corridoor from this surgery room, was another room with the recipient being prepared to accept the liver. The recipient’s liver is removed completely, all the blood vessels and ducts prepared, and the great saphenous vein is cut out from the person’s leg to provide extra blood vessel length for connection.

The clock struck 3:47 p.m. when the call came in that both the donor and recipient were ready. It  had taken 8 gruesome hours to reach this point, and the transplant of the liver was about to go underway. After such careful procedures until now, the actual movement of the liver is a comparitively crude and primitive process. No fancy or high tech piece of machinery, just an ice box that the liver is carefully put into. To minimize ischaemic (due to no O2) damage, the movement of the box across surgery room is a somewhat panic striken shuffle across the corridoor.

That shuffle had made a part of me a part of my dad. Looks like I’ll always be there for him now. With a sly smile at everything I had seen today, I fell exhausted in the preparation room into a blissful nap.

After this major blind-siding, I thought back to how all the information and worry directed towards me had bounced off the shield of ‘knowledge’. One systematic review article had made me into an expert in liver transplants, that expertise was maintainable when the topic was of someone else. But, once I lay in the same bed I had scoffed at…. I really had no idea.

My abdomen feels exactly as it should. Like a surgeon cut open a wound, took out the right lobe of my liver, took out my gall bladder and reconnected the many blood vessels and ducts of my liver. I push the button to inject my body with more of some weak PVC crap instead of morphine that’s had minimal effect since this afternoon. A steady flow of it enters into my neck – I know because I can taste it along with my IV drips for nutrition. I know biologically I shouldn’t be able to, but I can’t escape the feeling like the insides of my mouth has been covered with an IV tasting layer of glad wrap.

My drained strength kept me from opening eyes to see and talk to the many visitors who had come in to wish a speedy recovery. Every visitor seemed to be compelled say those exact same words with a string of other cliché lines. They made no attempt to hide the repetition of the line, either because it was easier to slip into a role they’ve already seen or because it really best expressed how they feel.

Is it that we have lived long enough with the English language that everything has already been expressed? Our confessions of love, words of encouragement, jokes for the laughs, sympathetic phrases… How much of it was original? How much of it could be?

There seems to be another thing about pain, it makes me make half-hearted stabs at philosophy.

Day 2.
Today, I exceeded my limit. At 3 a.m. my body was drenched in the sweat of exasperation. I grasped at the bedrails and on my way up, ironically I snapped and fell way down in my head. Pain had been too much part of my life for too long, and I cried both out and literally. I shocked myself, I had been keeping everything under the lid just 5 minutes earlier, and with a short passage of time I was begging to be helped from it all.

Pain had become my Michael Jackson.

Those kids who went to Neverland, would’ve laughed at the aspect that he liked his kids a little too much. When they get there, they find that the giraffe’s neck is not the only stiff rod in the zoo of a house, and after the consequential relief of the stiffness to the horror of the children, they will be rewarded with a multi-million dollar lawsuit. False expectations – harsh reality – great reward.

So, going back to the crumbling me, my mother ran out to yell for a nurse. They arrived with a painkiller, and injected a large dose into my veins. The relief was almost instantaneous, and just as I was thinking medicine was a miracle, the catch of medicine kicked the wind out of me, literally. It felt as if some douchebag smashed me over the head then stuck two fingers down my throat making me nauseous, vomittus (wanting to vomit – don’t look this term up in the dictionary though… I made it up) and unable to breathe.

A hurried oxygen tank ended the day for me. It’s actually worth it to have the douchebag do what he did, because it relieved me from what the surgeon did. The side-effects of the opioids wore off in less than 30 minutes, giving me hours of doped-up joy and sleep.

Day 3.
Did you notice the lack of the mentioning of the person who all of this is for? I couldn’t escape the self-absorption of this particular suffering to muster a sustaining concern for my dad. The resident surgeon had told me earlier that the liver donor hurts more than the liver recipient – not because we really hurt more than the receiver, but because the amount of pain relief medication is just that comparably different.

The nurses here have 3 different pain medication at their disposal at this hospital. My body had side-effected to the one yesterday, and it decided to reject the other 2 with a worse reaction to one, and a loss of the relief to the other that had successfully worked on Day 1.

I had done my summer studentship (a research project) on pain. During the literature review, research revealed the harm of pain and exposed some dire long-term consequences – it was no longer about toughing out the moment and believing in the benefits of getting better on your own. My brain had been the only one absorbing all this information whereas my body still seemed to believe one thing. “Harden up mate.”

Fine, no more pain medication. No more blogging about it either. Instead I’ll make the rest of my stay at the hospital into a list.

Days spent at the hospital: 11
Days I wished I wasn’t at the hospital: 3 (Hospital intrigue could only take me so far, plus by Day 8 I had explored every nook and cranny of the 3 building complex available to the public).
Days I was promised discharge but stayed with fluid leakage from the liver: 1
Days with a lot of pain: 3
Times I wake up at night sweating from the discomfort since Day 4: 3
Injection holes in my arm: 14
Injection holes in my neck: 3
8×4cm bruise from poor injecting skills: 1
Loss of reserve inspiratory capacity (Max volume of air inspirable after maximum expiration): 1200mL
Regain of that loss: 900mL (With exercise)
IV fluid entered into my body: 5L
Peak no. of IV drips simultaneously: 4
Dad’s peak no. of IV drips simultaneously: 9
Staple holes in my abdomen: 48
Staples pulled out of my abdomen with me looking: 24
Blood pouches draining my abdomen: 2
cm of tube pulled out of my abdomen: 50
cm of tube I wanted to watch getting pulled out of my abdomen: 50
cm of tube I actually watched: 15
cm of tube pulled out of my nose: 10-15
No. of CT scans: 1
No. of Hepatobiliary scans: 1
No. of X-rays: 4
Kilometres walked: 25 (Exercise is recommended from Day 2 onwards, becoming especially important from Day 4 onwards to reactivate the GI tract)
Times those kilometres got me in trouble: 2 (Both times from venturing into ICU)
Kilometres walked wishing that I had a Mp3 player : 24.9
Minutes spent with a Doctor: 20 (That’s over the 10 day span, including a 10 minute session obtaining consent before surgery. This did change somewhat on the last day when the resident doctor opened up a little bit.)
Days spent by my resident surgeon in the hospital: 5
Metres walked by that doctor on his venture into fresh air: 10
Hours slept on a daily basis by the same doc: 1 (Completely ridiculous the workload the doctors are under over here.)
Words I wish I had the opportunity to say to a Doctor: A summarised 200
Number of verbal consent asked by the Doctor: 0 (I remember a time when a doctor shook me awake, and before I could shake off the grog, she was already busy removing my IV drip needles from my neck)
Times spent bent forwards washing my hair wishing I was having a shower instead: 6
Times I had a shower: 0
No. of beautiful of nurses: 6
No. of beautiful radiologists: 1

So concludes the mind of a liver donor.