i am tom hanks

i'm sitting here. after reading emails. and there is this whirlwind of unrest within me. the storm grows larger and larger, consuming my organs one by one. it makes me dizzy. i want to lie down after drowning in wine. to hide from today. surely it must be visible, obvious to others. this stormcloud, this roar of the thunder, this dark shadow that clouds me. apparently not. the bees keep buzzing away as this giant hive continues to hum, happily without me. i am dressed well, my posture is normal, and i still speak and interact normally. there is no formal thought or speech disorder, and no evidence of psychotic phenomena. there is denial of suicidal ideation. insight intact and good judgement. but what in the ways of mood and affect? what in the ways of ruminations? i digress. i must be getting lost in the storm. when can i escape this day of meetings and sessions and things to do and things to tick off my to-do list? am i going to be tom hanks in 'the terminal'? am i going to go to heathrow airport on 3 november and be told, 'i'm sorry sir, but the world you knew, the world you came from, does not exist any more'?

last few pics from zambia... sniff sniff

some pics from last weekend

statue at picadilly circus (i've forgotten its name, sorry)


picadilly circus


the national gallery
yum char (mmmm)


portobello road and market




yours truly at trafalgar square

trafalgar square


my quaint little street


paella (mmm)

blood and dog pooh

yesterday i attended an inpatient ward round at the maudsley hospital. what an experience! my fascination with schizophrenia keeps increasing and increasing.

today i visited the oldest psychiatric hospital in the world, bethlem hospital. it has changed a lot from the old 'asylum' that it used to be in the past, from where the terrible 'bedlam' imagery comes from. it's a villa style hospital, with each ward/department occupying a building, and all the buildings spread out over a large area, amongst fields of grass, fountains, trees. it's lovely just to walk around the site. it's an amazing place, with departments covering all areas in psychiatry, from eating disorders to forensics to special psychosis units. i visited the inpatient cognitive behavioral therapy unit that deals with the anxiety disorders, in particular obsessive compulsive disorder, the simple and social phobias, and body dysmorphic disorder.

worked with one of the world leaders in cbt, ocd and bdd, dr. david veal. it was fascinating seeing him in action.

it was also fascinating spending time in the 'longfield house', a 'hostel' of sorts where patients live during the 12 or so weeks of therapy they receive here. you'd think it would be a disaster, having all this ocd cramped together, but it works, and actually helps!

doing some cbt with a lady with ocd was a great experience. discussing her magical beliefs and obsessions and compulsions surrounding contamination with blood and dog faeces, increasing her awareness of the cognitive aspects of her illness, and finally going out for a walk outside on the grass in the sunshine, picking up acorns, rolling in the grass, walking amongst poohs of various types (i.e. doing lots of exposures and ritual preventions, and having a jolly good time as well), was very rewarding. she used to be one of the most severe cases of ocd.

change, in mental and psychological dimensions, is hardly ever anything but slow and gradual, and is almost always fraught with difficulty. there are no quick 'fixes' in the 'bone broken. so lets puts it together and fix it sort of real good' kind of way. and outcomes are subtle, and hard to measure quantitatively. the smile on a person's face, the spring in the step and a twinkle in an eye, the ability to get out in the sun and laugh about oneself - these are all signs, no matter how small, of healing.

it's all real. it works. and it's rewarding and satisfying.

frig

so many photos to show you all.

but.

i can't seem to be able to upload them here!

funny how i could upload pics from a prehistoric computer in rural zambia, but not from here.

frig.

oh well, you'll just have to imagine how beautiful everything is :)

hope all is well back home! keep keeping in touch! :)

weekend activities

i had a great first weekend here in lond-on!

highlights included:

saturday i decided to explore the 'west end'
- full cooked breakfast at nearby café to start off
- massive sports store lillywhite's at piccadilly circus
- trafalgar square, nelson's column, the crowds of people, the sun, the fountains
- the national gallery - massive art collection and an awesome exhibition of some of the more modern masters, monet, renoir, picasso
- yum char for lunch! delicious food and excellent service at a highly recommended restaurant in chinatown. it was fun dining on my own (and the staff found me quite amusing) - the only problem was i didn't order like i was on my own. 9 dishes, 2 specials, 1 super special, and three pots of tea later - i was stuffed beyond belief. my solo yum char experience lasted 2 hours and in the end cost me a whopping £34. remember that £1 is about NZ$2.80, and you can believe my shock! it was worth it though. seems like the legacy of "quick and cheap yum chars" is international.
- browsing through countless bookstores and music stores, doung lots of window shopping, and not actually buying anything (see cost of yum char above)
- watching 'miami vice' - a very cool movie, very michael mann. great action, cinematography and soundtrack, and the love story is very heartwrenching

sunday
- sleeping in
- getting lost a thousand times (there were major works on rail, underground and bus routes so there were many detours/alternative routes to be made)
- portobello market, wonderful architecture, atmosphere, sunshine, albeit average products on sale at the market stalls
- the most amazing seafood paella i have ever eaten (and lots of wine)
- vanilla cupcake from a store that makes 'the best cupcakes in the world'

as you can see, i have a lot left to see and do in london!

an exciting day

today so far...

- waking up, trying to deny the fact that i had to get out of bed, remembering what's been going on the past few weeks, struggling with the reality that i was two billion miles from home in a foreign land, trying to go back to sleep in between every 9 minutes of my phone alarm going off: 2 units of time.
- breakfast panini (with guacomole, cherry tomatoes and ham), 'cup o tea', shower and shave, and getting dressed: 1 unit (believe it or not!).
- catching the double decker to work in the drizzling rain with bloc party playing loud on my earphones: 1 unit.
- getting lost in king's hospital trying to find liaison psychiatry department: 1 unit.
- getting very warm and enthusiastic welcome from liaison psych dept, sorting out a timetable, slotting me in on the various clinics (chronic fatigue syndrome, neuropsychiatry, endocrinology & diabetes, perinatal, amongst many others), having two cups of coffee: 2 units.
- talking to consultant about her elective in australia, her initial dream of being a tropical medicine doc in a third world country before incidentally discovering that she has complement deficiency, her choosing psychiatry and what she loves about it - the uniqueness of each patient, their life stories, their hopes and dreams, the new and exciting research, using one's mind, learning about oneself as well, and the significance of psychological problems and the importance of treating mental illness, and getting thoroughly inspired by this conversation: 1 unit.
- attending fascinating lecture by an eminent professor and researcher, professor ming t tsuang: 2 units. he's from taiwan (perhaps tracy's father may know him?), did research here at the institute of psychiatry, and then went to the states where he has done lots of groundbreaking research on psychosis and schizophrenia. thoroughly stimulating lecture on his research to date, the genetics of schizophrenia, and the interesting concept of 'schizotaxia' - where there are neuropsychological deficits and negative symptoms - in first-degree relatives of people with schizophrenia (all of them, even those with no positive symptoms), and *before* the prodrome and onset of schizophrenia. fascinating concepts that are inspiring research that may lead to a better understanding of the polygenic predispositions or determinants of schizophrenia, the schizophrenia blood test (!), and identifying schizotaxia and the phase before the prodrome, thus being able to 'prevent' schizophrenia.
- lunch of vegetable korma and rice: 1 unit and £2.50.
- seeing patient on ward with end-stage multiple sclerosis: 1 unit.
- organising to attend ward rounds on one of the inpatient wards for the next few weeks: 1 unit.

now i'm here at the library. pondering which book of mine to read - 'the history of psychiatry', 'freud for beginners', oliver sacks' 'the man who mistook his wife for a hat', anthony storr's 'solitude: a return to the self'.

i know, i know. you guys must want to hassle the heck out of me after all this! but really - it has been such an inspiring day! this place is amazing. the people, the research, the passion. i love psychiatric people - they're so passionate and so welcoming, and - human. (i'm generalising of course, and there are lots of other people like this in other specialties, apart from orthopaedics). i love the research and i want to do my own (i can see hoon's smug expression right now!), i love the passion people have for psychiatry, i love how people realise the reality of mental illness, its significance, and the importance of treating it. i love the mind, the fundamental centre of our existence and our place in the world and universe, really.

oh. and i love london. it's a huge city. one can really slip into complete anonymity here! people always talk about how londoners don't do small talk with strangers, don't smile and say 'hi' on the streets like in nz, and how the underground, no matter how busy, is always eerily quiet. but it's nice, in a way, to be anonymous. to quietly go about your day, filling up your units with various activities. it's nice just slipping off the side and watching this huge organism pulse to its daily rhythms.

yesterday evening i caught up with matthew. we had japanese food and asahi (ahhhhh!), walked around town (trafalgar square, piccadilly circus, big ben and the houses of parliament, the river thames and london bridge all in one evening, without even trying!), had a few ciders at a bar on a boat parked on the side of the thames (very cool!), and talked about life love politics music and current affairs. he's gone through a rough time in the last year, and i was embarassed to realise that i never picked up on the signs, and was never really there for him.

so what shall i do this evening? catch the train into the city centre, go to covent garden and get caught up in the street events, the crowds of people, the sights and sounds, have dinner and a drink, watch a movie or a play, go to trafalgar square and ask nelson what he thinks the meaning of life is, sit under the giant neon lights in piccadilly square and watch the crowds of people go buy, or try my luck at some solo clubbing action? actually the weather's pretty miserable, so i think i may just have a quiet night - maybe a bottle of wine and dinner at the wine garden near my house, or just a beer and a frozen meal (the frozen meals here are excellent! and cheap!) at home?

dha

first week in london

hello everyone!
what a change from zambia! (no? really? duh!)

it's been a tough couple of weeks for a number of reasons. malaria. pneumonia. and especially because lots of tough things have been going on at home since i've been away. the whole european experience is going to be different. and i don't know how things are going to be, when i come back home.

it's interesting, how swiftly the winds of life can change things! one day you can be certain about lots of things, the next day it can all change, and the only certainty - sorry for the awful cliché - is uncertainty.

i guess for that reason it's important to know that the only real time we have is - now. it's important not to postpone things. it's better to over-express than under-express one's appreciation, gratitude, love, hopes and dreams with one's loved ones. because tomorrow may be too late.

anyway. i don't think this blog will work very well as a journal for my innermost, most personal experiences. i don't think i can, or should, lay it all out in the open here. i just have to say though - thank you to all those who support me, and are there for me. it means so much to me.

so. being so far away from home and having so many things to worry about has not been easy. i was so happy that matthew oliver met me at the airport. it was very nice seeing a familiar face. it's nice to know that there's a kiwi close by.

i am staying at a homestay in east dulwich in the south of london, which is a ten minute bus ride from where i am working, at the maudsley hospital. it's a nice little house, inhabited by a psychotherapist (the owner), her daughter, and a spanish research student who works at the institute of psychiatry. the houses are narrow and all stuck together, but they're tall. i have a nice spacious room with a super comfy double bed, a tv, a wardrobe, and nice big windows.

so far i haven't travelled much around london. just been getting settled in, doing grocery shopping, exploring dulwich village nearby with its quaint streets and shops and restaurants.

in terms of work - so far i have just been introduced to everything, sorted out a timetable, and attended some teaching sessions on cbt (cognitive behavioral therapy). the five weeks here promise to be an interesting experience, i feel, an experience almost completely different to my experience in zambia. my time will be spent in the following ways: sitting in on as many psychotherapy assessments (psychodynamic, cbt, family and group) as i can, attending teaching sessions, attending seminars and presentations, grand rounds, helping out with an rct on bulimia and the use of internet-based cbt, days with the liaison psychiatry service at the nextdoor king's hospital, a trip to the ocd ward, hopefully some days on the wards and meeting some contacts i have been linked to, and also lots of free time - for reading and reading (there is the most amazing library here at the institute of psychiatry), and mucking around on the internet, like what i am doing currently.

i am reminded of a super quote from the movie 'about a boy':

"I find the key is to think of a day as units of time, each unit consisting of no more than thirty minutes. Full hours can be a little bit intimidating and most activities take about half an hour. Taking a bath: one unit, watching countdown: one unit, web-based research: two units, exercising: three units, having my hair carefully disheveled: four units. It's amazing how the day fills up, and I often wonder, to be absolutely honest, if I'd ever have time for a job; how do people cram them in?"

and so it seems, that i will have to master the art of making up days and things to do to fill my consciousness over the next five to six weeks.

the silent patches in between units are tough. during these patches the mind wanders and distresses itself over distressing thoughts and ruminations. these are trying times, but i am trying to keep myself occupied as much as possible. this weekend i plan to go to the city and do some sightseeing, eating, exploring, and other touristy things.

i think i have blabbed for long enough now, trying to kill this empty hour before lunch! more updates next week!

hope everyone and everything is well,
thanks for all the support,
dha

happy birthday ilia!

happy birthday to you!
happy birthday to you!
happy birthday dear kuma ilia polar bear biggie bigz buoy!
happy birthday to...

youu-eeeeeeeeeeeeeeeglassshattersdogshowlingchildrencryingeardrumsburstingeeeeee!



sounds like you had a great day moight. with four girls? did lola know about this, you dog? what a guy. what a p.i.m.p.u.s.-i-am-going-to-celebrate-my-birthday-with-four-hot-girls-in-sunny-malta-and-not-invite-my-friends-and-i-will-take-over-my-friend's-blog-kinda-guy, guy.

all the best for the years ahead, bigziebiggiebigz.

people should put their names to their words, if they mean anything.

recovering from malaria.

now have 7 weeks of not knowing anyone in europe to look forward to.

unravelling, unravelling.

p.s. certain anonymous people have been leaving comments. strange that it comes only after i told certain people about this blog.

trouble in paradise

highlights:
- seeing victoria falls. even though it's dry season and the falls aren't as huge as they could be, it was still amazing.

lowlights:
- getting malaria. badly.
- things seem to be slowly unravelling.
- being so far away from home and everyone who's dear to me, while this unravelling is taking place. so, so far away.

final week at saint francis

highlights of the week:
- admitting young girl who was very, very sick and diagnosing tb pericarditis, being correct, treating her and curing her. we were all so totally elated when she walked out of the ward, the biggest smile beaming on her face. successes like that make it worthwhile. make you remember what you’re in this madness for.
- the same girl, every time she would see me walking towards her end of the ward, (because everytime i saw her i wanted to listen to her chest), would sit up and whip her blouse and bra off. and i had to run over and stop her because i wasn’t actually walking over to see her just yet. madness. this happened several times. she just didn’t think twice about flashing her mammaries at everyone.
- 2 female patients asking for my phone number and address. this now makes the score (people who have asked for my numbers from the wards) - 4 male - 2 female, and one unknown (the ‘female’ at the king’s bar who had a huge gob).
- seeing patients get better, and smiling. my favourite patient on the ward at the moment is this 19-year-old girl who has a relapse of tb and has the craziest chest x-ray in the history of chest x-rays, but who is quite asymptomatic and is cruising around laughing and joking. great fun.
- diagnosing psychiatric problems when they have never been considered and no one else could figure out what was happening.
- mosi.
- playing basketball till after sunset.
- the safari. oh my gosh did i mention the safari?
- the ‘hamburg’ sausage i ate today. only 5000 kwacha too.
- looking forward to next week: going to livingstone and doing touristy things like vegetating around pools with all these pasty white people around, drinking copious amounts of ethanol, going to the *amazing* victoria falls, canoeing, white water rafting, and so on.
- chilling with the irish boiz, talking arrrish and shutting our punts.
- knowing that the highlights far outweigh the lowlights. and knowing that most of the lowlights are kind of highlights in their own way.


lowlights of the week:
- tracy reading the above stories and thinking that i am having a wonderful time in zambia with all these guys and girls and guygirls and patients flashing me.
- seeing patients, especially young ones, not get better.
- never being able to get used to the wailing from families when someone dies. it *always* gets to me.
- knowing that i will be leaving st. francis this week. i feel that these five weeks really haven’t been enough! a big part of me wishes i had another week! i am enjoying everything so much, learning and doing so much, experiencing so much. i think five weeks is not enough at a place like this.
- the score is still 4-2, and i only have two days left.
- having an argument with a nurse who insisted that i should prescribe an ‘appetite’ pill (FeSO4) to a patient.
- the same nurse wondering whether i was from china. don’t ask. i can’t figure it out either. and i’ve been thinking about it for days.
- this feeling at the moment that that ‘hamburg’ sausage is having a party in my bowels. and no, it’s not the good kind of party.
- filling up my bucket with a lovely two kettles of hot water. then putting the cold tap on to fill up the rest of the bucket while i brush my teeth. then getting distracted and coming back to find that the whole thing has overflown, leaving nothing but a cold bucket to bucket with.

lost in translation

so many things get lost in translation here. it’s very difficult sometimes to get a good history from patients. and the history is the most important part in diagnosing problems. having to use a translator not only makes everything take three to four times as long, but it also forces you to use closed questions most of the time, which, as you will see, can make things so much more tedious.

interesting anecdotes from a different world.

dha (d): are you passing urine more frequently?
patient (p, via translator): yes.
d: how many times are you going now?
p: once a day.
d: ok... so how many times were you going before?
p: once a day.
d: so going to the toilet once a day now is more frequent than going once a day before?
p: yes.
d: ok.
....
d: when was your last period?
p: 18 august.
d: how many days between your periods?
p: 4 days.
d: 4 days of bleeding?
p: yes.
d: ok. and how many days till the next bleed?
p: 4 days.
d: and then you stop bleeding?
p: yes.
d: ok. so that’s how long your period is. how many days (frantically using all kinds of sign language with my hands and feet) between one period and the next?
p: 4 days.
d: ok... when was the period before your last one?
p: i can’t remember.
d: ok.
......
d: how long do your periods last?
p: i bleed every day.
d: you bleed every day?
p: yes.
d: for how long has this been happening?
p: ever since my caesarean section 3 years ago.
d: so since your c-section 3 years ago, you bleed from your vagina every single day?!?
p: yes.
d: are you bleeding today?
p: no.
d: did you bleed yesterday?
p: no.
d: did you bleed last year?
p: no.
d: ok...
........
d: how are you feeling today?
p and translator talk for about 3 minutes, before announcing: fine.
d: what did you talk about in all that time?
translator: nothing.
......
my favourite translator in clinic is a little on the slow side. very, very, very frustrating. but she’s so friendly and always has a huge smile on her face, so it’s also very hard to be angry with her for very long.
d: how are you feeling today?
translator (t): fine.
d: that’s grand. how is the patient feeling?
t: she’s fine.
d: could you ask her please?
p: i have a headache. i have an appointment at the hiv clinic.
d: (asking translator) do you know where the hiv clinic forms are?
t: (asking patient) do you know where the hiv clinic forms are?
p: um. no?
d: no, do *you* (pointing to translator) know where they are?
t: ohhhh!
d: so?
t: no.

pronouncing deaths

5 september

as you enter the room, trying not to show your distress too much. as you pull the blanket off his head. as you feel his carotid pulses, as you pull his eyelids open and shine a dim light of life into those huge cavernous depths. as you sit there, your stethoscope over his chest, listening for the beating heart and the waves of breath. as you sit there with your stethoscope in your ears you are suddenly distanced from the wailing wife and daughter. it is just you, your thoughts, and, via that tube - him. as you suddenly have these few minutes, take the time to look at his face, and to think about what it meant to be him. think about his grey hair, his stately face, his thin chest boasting thin ribs. think about his life. and as you think about all this, also think about yourself. were you not flustered when he was wheeled into the emergency room? were you not frustrated when he seemed to complain of every possible symptom. headaches, neck stiffness, cough, chest pain, abdo pain, increased urinary frequency, inability to walk, back pain and numbness in his left foot. why couldn't he walk? surely he was just making that up? wasn't there the slightest hint of malice when you made him walk for you to see? for you he was a pain, an irritation. for him you were the person he had come to for help. for everything you could not understand about him, there were thousands of other things that he was afraid of. would he ever walk again? was he going to live to see his grandchildren being born?

patient unresponsive.
pupils fixed and dilated.
no carotid pulses palpable.
no heart sounds or breath sounds heard on auscultation for three minutes.
patient pronounced dead at 1530.

i'm so sorry.

pancake party, harry, and ingrid and mo's farewell barbeque

this is harry. he's lost a lot of weight recently. but he still knows how to rock the party.

wild animals and hoon

what was hoon doing following me around?!?
this is a lioness at night. if you squint and wiggle your left big toe, you can kind of make her out. it was amazing seeing a lioness walking a few metres from our safari jeep! also saw a bunch of them chasing impala! no male lions though :( the lazy bastards must have all been fast asleep.

i took over 2 gigabytes of videos and pics at the safari! i have a *lot* to show you guys when i get back home!

happiness and elephants

i have to confess.

i am happy.

that one week earlier was tough. really tough. tough enough to break someone. but now i feel so strong. these last two weeks in clinics and on saint monica (the female medical ward - i swapped out of the male ward) have been going so well. i feel like i am in control of things - i have to ask fewer than a question a day on the ward rounds, and i am doing pleural taps, ascitic taps, lp's and everything with relative ease now. it's a great feeling. and the social life has been excellent! we had a big barbeque on thursday night and a crazy party on wednesday night (wo - reverse chronological order - wo) as kind of farewells to the dutch medical students who were leaving. fantastic fun.

so here i am at flatdog's resort at south luangwa national park. faster and cheaper internet but no photos unfortunately. i spent the night in a tent by the river. it was amazing! like jurassic park amazing. hippos wailing all night and splashing in the rivers. and this morning - elephants eating off the trees right outside my house! i was sitting in a chair outside as these magnificent creatures ambled in front of me, literally less than 2 metres away from me! it was fantastic. i remember from my childhood days how magnificent they were, and i am glad to say that they still are huge and graceful in a titanic kind of way (i.e. it wasn't just because i was a tiny tot, and everything looked huge back then). and monkeys playing in the trees. seems like monkeys have the maddest parties.

went on a safari drive this morning. wow!
- lots of elephants and elephant babies
- monkeys
- baboons (reminded me of you, nirosh)
- crocodiles
- giraffes
- impala
- beautiful birds
- hippos
- buffalo
and many more..
but unfortunately no lions or big cats today... hopefully next time!

anyway must go now! photos and more stories next time!

thanks for keeping up the posts guys - your posts hoon make me laugh so hard! and rayji - how is soccer going? and ilia - sounds like a prehistoric experience over there! hehe sounds like zambia may be more advanced in some ways!

take care,

dha