So much for my resolution to post more on my blog!
I finished my elective back in Hanoi with O&G. It was certainly eye-opening (and eye-watering - brutal episiotomies!) but I found it quite frustrating and dull. Only one of the doctors spoke decent English, and he wasn't particularly interested in teaching or showing me around, so I often found myself at a loose end. And while I felt privileged to experience the miracle of childbirth (not first-hand, thank goodness), it got very boring with no-one explaining the finer points of the procedures.
A baby born via Caesarean
I witnessed an abortion that affected me more than I thought it would. The patient had rheumatic heart disease and was not expected to carry the baby to term, so the decision was made to abort the 15-week foetus. The patient had been given some sort of local or spinal anaesthetic before we arrived, but it was clear that she could feel the instruments and was in pain. She was not sedated. A 15-week foetus is about 10 cm long, so the doctors used the instruments to break it into pieces for easier extraction. At one point, a perfectly-formed foot was removed, about 8 mm long. That really got to me. It also bothered me that the doctors pointed out each part of the foetus as it was removed - in Vietnamese and English. The English was good for us because it helped us to learn, but I don't think the patient needed to hear the details. I wish she'd been sedated.
So with my elective finally complete, I made my way to Thailand for a long-awaited holiday! I spent a couple of days in Bangkok and crammed in some shopping and sightseeing, then headed south to Railay Beach, near Krabi. It was perfect - a sleepy resort peninsula only accessible by long-tail boat. It wasn't too packed with tourists, the beach was gorgeous, the sunsets were divine, and the food was delicious. I must admit I was feeling a bit of trepidation about spending a whole week at a beach resort by myself. It worked out well though, and I had a great time doing very little. I didn't realise how tightly wound I was until I started to unwind...
Transparent sea at Phra Nang Beach, on the same peninsula as Railay Beach
Sunset at Railay West Beach
Now I'm back in Sydney, with one more week off before I go back to uni. I start with Psychiatry, which I'll hopefully enjoy, considering I have a Psychology background.
Now to the blog. I'll continue to write here when I have something substantial to say (longer than 140 characters!) or photos to share. Otherwise, cast your eyes to the right and you'll see my Twitter feed. You're welcome to follow my tweets: @pathologic_kt
I like silence. I find it difficult to sleep unless it's very quiet. I wear earplugs to sleep back home in Sydney (I live under the flight path, on a busy street). And if I'm sleeping beside a snorer, well, that means I get no sleep.
So you can imagine that I'm struggling a bit with the noise in Vietnam. I feel like I haven't had a decent sleep since, I don't know, December? I also get migraines - I've had a few since being here, and let me tell you, they're not much fun. Thank God for triptans.
Having been here before, I knew that I would constantly hear horns - motorcycles, cars, buses. After a while you get used to them, because they rarely stop. And I'm staying in hotels, so of course there'll be noise from other guests and their TVs, and clueless hotel staff.
In Hanoi there are always renovations happening somewhere, and the workers start early and finish late. They're currently restoring the "footpaths"* in the Old Quarter, so that's additional noise.
My hotel backs onto Tin Street (Hàng Thiếc), where various tin products are constructed and sold. So from first thing in the morning until the evening, I hear hammering on metal and angle grinders.
Tin Street
In an earlier post I mentioned that I was woken on Tết (New Year's Day) by the sound of ABBA singing "Happy New Year". I waited for it to end so that I could go back to sleep, but it was not to be - I had to listen to the whole "Best of ABBA" CD. (It sucks you in though - I was singing along to "Super Trouper" in the shower.)
With music and TVs, there are only two possible settings here - off, and VERY FUCKING LOUD. Everything goes up to eleven.
In Hanoi, the other thing that gets you first thing in the morning is the loudspeakers that suddenly burst to life with either a woman speaking very loudly in Vietnamese (apparently, she's announcing the lotto numbers), or very loud music (a muzak version of Bryan Adams'"(Everything I Do) I Do It For You" was especially memorable).
And in the evening, there's a distinctive clanging noise that goes on for about half an hour. It's the garbage collector making the rounds of the Old Quarter on foot. Granted, it doesn't wake you up (unless you're trying to nap, WHY BOTHER?), but it's just another sound competing for your attention.
The garbage collectors in Hanoi's Old Quarter have nothing on the collectors in Hoi An though. One Sunday morning I woke at 6 am after hearing some repetitive music in the distance. I thought to myself, "Don't wake up KT, just roll over and ignore it." That worked for a few seconds, but then I realised that the music was getting louder. Before long, it was blaring in my ears. I stumbled out of bed and looked out the window. On the street below, a garbage truck was parked. The music was their way of letting people know to bring out their garbage for collection. Aaaaagh! After the truck left, there was no getting back to sleep - everyone in the hotel was awake and making noise. Very frustrating.
The worst sleep interruption I've experienced was in Danang. We stayed at a bible-recommended hotel that wasn't far from the Catholic cathedral. In fact, I could see it from the window in my room. However, on the first night, I was woken at 4:20am by the church bells ringing! It wasn't even a tune - just "dong, dong, dong, dong...". It lasted for about five minutes, after which I was well and truly awake. We soon discovered that this happened at exactly the same time every single night. Incredible. Luckily I found a different hotel for my second week, nowhere near the bloody cathedral.
View of the cathedral from my Danang hotel room
I do have some solutions for a better night's sleep. Earplugs are obvious. White noise is a good idea - one of the other students over here suggested turning up the air conditioner fan, and that's worked quite well for me. I've tried using my iPod, but I'm yet to find the perfect music that's loud enough to block out external noise, but calming enough to let me fall asleep (suggestions are welcome).
And then there are drugs. I came over here with a Stilnox prescription. I've used it several times and it's worked well. I wouldn't recommend using it if you have to get up at a specific time the next day - it's better if you can just wake when you're ready. One day at the hospital I was out of it all morning. Another student is using temazepam. When that ran out, she went to a local pharmacy and they gave her diazepam over the counter! She's reluctant to use that though, and has tried Valerian root, which they also sell at the pharmacy. So far, it's been successful.
* Actually, there's rarely room for people to walk because of all the motorcycles and bicycles parked there, and the families eating their lunch and dinner on plastic stools. It's much simpler to walk on the road and dodge the oncoming traffic.
I'm very comfortable with my own company. I lived alone for many years, and loved it (I have a housemate now, but I may as well be living alone). Despite this, I wish the situation was different. I'm so tired of not having a significant other to share my life with.
I've been particularly affected by this while in Vietnam. I'm spending a lot of time with two other med students from my uni (one male, one female). Both have partners at home, who they talk to every day. I don't really have regular contact with anyone from home. I've Skyped with my Mum a couple of times, and with my sister (and nephew), but that's it. Whenever the other students talk about their partners, it depresses me - I wish I had someone special to miss, or someone special who missed me. (Yes, I know my family and friends miss me, and I miss them, but it's not the same.)
I had a mini-meltdown in relation to this on (lunar) New Year's Eve. We'd been drinking for about seven hours, and I was also a bit hormonal, so it's hardly surprising that it all caught up with me. We'd just watched the NYE fireworks around the lake in Hanoi, and were taking silly photos with the locals. One of the other students said something to me about how he wished his girlfriend was there to experience it. It was weird - I was immediately struck by a feeling of overwhelming loneliness and despair, and walked away so that no-one would see me crying.
One of the female students from a different university spotted me, and tried to comfort me with a hug. Bad move - I'm not a hugger (unless it's a big bear hug). I shrugged her off quite rudely and walked away. All I wanted was to go back to the hotel and cry myself to sleep. Eventually the others talked me into staying out, and I had an OK time - we went to a smoky pub, and had street food at 4am (better than a dodgy kebab!). But I was putting on a brave face - I really felt like complete crap. When I eventually made it home, I did cry myself to sleep. Sometimes it feels good to do that (I know how strange that sounds).
Anyway, this situation isn't going to change while I'm on holidays, so there's no point dwelling on it. Sorry about the 'woe is me' post - I'm alone in Hoi An for the weekend, and I guess I'm feeling reflective.
If I never hear this song again, I'll be a very happy KT:
I've heard it several times a day since arriving in Vietnam a few weeks ago, and was woken by it far too early this morning (Tết - New Year's Day). It's insane!
Sorry for the dearth of posts - I've actually had plenty of time to post while here, but have lacked motivation. So my first resolution of the lunar new year is to post more regularly on my blog. Most of the hotels here have free broadband in the rooms, so really, I have no excuse.
Hanoi is just as I remembered it - busy, confusing, and LOUD. There are motorbikes everywhere - as well as cars, buses, and cyclos - and they all honk their horns incessantly. Crossing the road is scary! You need a lot of confidence to do it. Some people say you should just walk at a steady pace, without checking for and dodging vehicles, but I think that's crazy. My best method of crossing the road involves a bit of a shuffle, and making sure I'm on my toes in case I need to dodge a speeding motorbike. I've seen the surgical hospital - I DO NOT want to end up there.
Motorcycles everywhere
I'm comfortable getting around the Old Quarter of Hanoi without a map now, which is fantastic. I've done a few touristy things, like visiting Uncle Ho, riding swans (paddle boats) on West Lake, and visiting Tam Cốc (things that I didn't do when I was here two years ago), but it's been fun just settling into life as a resident of this crazy city. The New Hanoian has been very handy, as has the trusty travel bible. We've discovered some really wonderful places to eat, we've been to the opera (La Bohème), and last night (New Year's Eve) we even cooked spag bol for a big group of med students and hotel staff at one of my fellow students' hotels. We bought all the ingredients (except the pasta) from a street market - it was so fresh. The beef was fantastic. And it was so great to be cooking - I love to cook, and was already missing it.
Swans on West Lake
I've gotta say, I'm not loving the local food in Hanoi. I find it a bit bland and greasy, especially when compared with food from southern Vietnam. And I know this is blasphemy, but I don't really like phở bò. There, I said it! I'm just not a noodle gal. That said, I have eaten it and haven't minded it, but I certainly won't go out searching for it (and would never eat it for breakfast like everyone else does). I'm heading south tomorrow (Danang and Hoi An), and I'm really looking forward to eating some of the local specialities, such as white roses (shrimp dumplings) and fried wontons.
I did a good cooking course though. We prepared Hanoi street food - BBQ pork strips and meatballs, noodle and herb salad, spring rolls, and dipping sauce. Unfortunately, I'd woken that morning with a stomach bug, and spent most of the class in the (thankfully clean) bathroom. It was only a 24-hour bug, and I've been otherwise really well.
Spring rolls - deep fried for half an hour!
I'm here with four other students from my uni, and four students from an interstate uni. We all get on well, and have had plenty of fun out and about in Hanoi. Some of the students have been very keen, whereas I've been more inclined to take it easy and have a half-holiday, half-elective experience. On each weekday, I tend to be at the hospital until about lunchtime (sometimes finishing earlier), with afternoons free for sleeping, sightseeing, shopping, etc. Perfect! I do plan to step it up a bit in Danang next week, because there won't be as much to see and do in our spare time there. We've been told to take this week off because of Tết - quel domage!
There are three major hospitals in Hanoi - Viet Duc surgical hospital, Bach Mai medical hospital, and the Paediatrics hospital. I've spent most of my time at Viet Duc. I did a week of neurosurgery, a week of orthopaedic surgery, and a few days of Emergency before heading to Halong Bay last week. I also visited the Paeds hospital one day - my koala bear toys were a big hit with the sick kids (and I still have plenty more to give away, probably in Danang).
Viet Duc hospital has been an eye opener. The thing that's really struck me is the lack of pain relief. I think it's a cultural thing - the Vietnamese people appear to be very stoic, and they don't complain when they're obviously in a lot of pain. The strongest painkiller I've seen on the wards is IV paracetamol. I haven't spotted morphine anywhere yet. Even amputees only get IV paracetamol.
IV paracetamol
The main mechanism of injury at Viet Duc is motorcycle accidents. Vietnam brought in a compulsory helmet law at the beginning of last year, but the poor quality of the helmets and the fact that they're rarely fastened properly mean that serious head injuries are far too common. Limb injuries tend to be catastrophic. Other reasons for visiting the Emergency department are machinery accidents (I've seen many mangled hands) and falls from building sites.
Communication is a big problem for us at the hospital. Some doctors speak English (some better than others), and only a few of the medical students speak English. None of the patients (so far) speak English, which makes it hard for us to perform examinations, and obviously impossible for us to take histories. So unfortunately that means we're reduced to standing around, observing. It doesn't take long for that to get boring. We have been learning some Vietnamese language, but certainly not enough to allow us to converse. (A lot of people at the hospital speak French, so I've been trying to access some HSC French in the deep recesses of my mind, with limited success.)
The operating theatres aren't as sterile as we're used to in Australia. I watched brain surgery while the window to the outside world was open! And I wore open-toed shoes! Although there's a sterile field for operations, the surrounding environment feels decidedly less sterile. We got the sense that people were going through the motions of maintaining a sterile field, without a clear understanding of the theory behind it. We saw some surgical instruments being rinsed after one brain operation and re-used in the next operation. We're trying to remain open-minded - who's to say that Australia and other Western cultures don't go overboard with sterility? We really want to know what the post-surgery infection rates are like, but we don't want to sound arrogant - and we doubt that the statistics will be available.
Open-toed shoes - we have to change into these before going to theatre
The surgeons are excellent, though. Most of them have done some training overseas. For example, one neurosurgeon trained with Charlie Teo in Sydney. They've been friendly, and the surgeons who can speak good English are keen to explain the operations they're doing. However, I'm not interested in being a surgeon, so I'm kind of over the standing around and watching. I'm hoping to get some more hands-on experience in Danang.
The triage area of the Emergency Department is run by medical students. It's been frustrating to watch them faff about with seriously injured patients. For example, we've seen patients with major limb injuries, but no pressure on wounds, no fluids, no pain relief. The students seem to be very good at checking pedal pulses, though - each patient has their pulses checked by at least five students! And they tend not to use supraorbital pressure or sternal rub to test pain response - they do massive nipple cripples instead! We saw one severely comatose patient nipple crippled by several successive students and doctors, until his chest was bright red.
There are a few security guards dotted around the hospital, with megaphones and batons - both of which they love to use to control 'unruly' family members. One patient came into the ED with a severe head injury (actually I think it was the nipple cripple patient), and his daughter came into the room, sobbing while standing by his side with other family members. The security guard came in and stood next to her, then yelled at her through his megaphone, telling her to get out. Guess they don't like public displays of emotion.
I visited the neurosurgery and orthopaedics wards. Both were overcrowded, with beds in the corridors and in spare spaces in each room. I counted at least 15 white coats on the rounds, so there was very little room to move in the crowded rooms. There are also people in yellow coats on the wards - they're family members, who stay in the hospital to help care for their relatives, because there aren't enough nurses to go around.
Wow, this is a long post. That'll teach me to post more often. Congratulations if you've made it this far! Not long to go...
As I mentioned, tomorrow I'm heading to Danang and Hoi An. I haven't booked a return ticket, because I'm going to suss out what it's like down there before deciding how long to stay. Ultimately I have to fly out of Hanoi at the beginning of March.
I just finished listening to the Hottest 100 streaming online (predictable but fab number one) - gotta love the free internet! We were planning to find an Aussie pub for some Australia Day beers, but after a massive NYE we all need afternoon naps and an early night.
Chúc mừng năm mới!* I'll try to stick to my new year's resolution.
Since the exams ended, I feel like I haven't stopped. My mind is constantly racing, and I have several to-do lists. I really need a holiday...
The first week of December was taken up with visiting my gorgeous new nephew, and preparing for a close friend's wedding. The wedding was fantastic! I was in charge of the music, and I also did a reading - both went well. The reading was unusual. I was the narrator for this story:
Two days after the wedding, I flew to South Australia to begin my John Flynn placement - a rural placement that takes place over two weeks each year, for the four years of my medical degree. This was my third placement. Unfortunately, I was BORED. I got the chance to do some anaesthetics, which was good. I assisted on two Caesareans (and stapled up one patient's abdomen), and I spent an afternoon at the Pap smear clinic (a tad confronting, as you can probably imagine - but great experience). I spent most of my time seeing patients in the drop-in medical centre (part of the GP practice I'm allocated to). But overall it was medically and socially dull. My attitude didn't help - all I wanted was to be on holidays, not using my brain for medicine - especially after such a crappy year. Thankfully one of the doctors saved me from complete boredom - he lent me his car for the whole weekend. I drove to the Clare Valley, a place I'd always wanted to visit. I bought quite a lot of wine and had a divine lunch at Skillogalee:
I arrived back in Sydney just before Christmas. Luckily I'd completed my shopping before I left, because I had to launch straight into Christmas Eve lunch with Dad, then Christmas Eve drinks (too many) with friends, then Christmas Day at Mum's place (too much food and wine consumed), then Boxing Day at my uncle's place down the coast (again, overindulgence).
Then it was back home again to make a dent in my to-do lists. Why so many to-do lists? I'm leaving for Vietnam tomorrow - my two-month elective. Following that I've got 12 days in Thailand (finally - a holiday!), so I had a lot of fiddly bits and pieces to get done before leaving.
Oh yes - and I had to hit the sales! I bought several tops, one pair of pants, two skirts, and lots of books. I didn't want to buy too much because I'm going to get clothes and shoes made in Vietnam. (And also because I need to lose weight.)
So I'm on the plane in less than 12 hours - eek! I've been to Vietnam before, so it won't be a complete culture shock. And there are several of us going, so it will be loads of fun. Can't wait!
Hit 30 and decided to change careers, so now I'm a doctor. It's good, bad, fascinating, mind-numbing, but ultimately wonderful. I think I've found the thing that I should be doing. I hope.
