Monday, 16 November 2009

Worm compost

I don't have a green thumb.

Mostly this is because I'm not good at routines and habits.  So I forget to water and tend my plants ... or let's say I choose not to remember.  As a result, my balcony garden looks like this:

Gardening tools: trowel and gloves (which may contain spiders, I don't know).  One planter which formerly contained bok choy and lemon thyme, which the caterpillars promptly ate.  The red ice cream tub contains the little pots that the bok choy and lemon thyme came in.  The two other pots are the remains of tomato seedlings I bought a few weeks ago in a flutter of enthusiasm.

Okay, I do have an excuse for not putting the tomato plants in the planter, and for not watering my planter.  Here is the reason:

It is supposedly a 'self-watering' planter.  In theory, water drains from the soil into a separate compartment at the bottom and can sustain the planter for a few days.  Excess water can be tipped out through the letterbox-shaped hole in the picture.

In practice, mosquitoes get into the water compartment through the hole, and breed there :( After that, I avoided opening the balcony door at all until the plants were dead.

I did buy some mesh to put over the hole, before I bought the tomato plants.  However I never got around to taping it on.  Or watering the tomato plants more than once, come to that.

Okay, so I can't sustain green life.  Hmm.  What can I do for practice?  Compost maybe?  After looking a little while at composting information, I decided that my planter would make a perfect worm compost farm.  All it needed was a lid with airholes, and mesh over the water compartment. The water compartment would  drain the compost so it didn't get too wet, and the lid with airholes would stop little flies from getting in the top and laying maggots.

Went off to my nearby hardware/nursery store (looking for lightbulbs, as it happened) and asked the DIY man how I could get a lid for my planter.  He suggested that someone could just cut a piece of plywood into shape, put a handle on it, and off I go.  He even offered to do it himself, when I said I didn't know anyone who had materials to do it for me.  He refused my offer to pay for materials, too.  I better bake him a cake or something.

He measured a planter that was in the shop, to make the lid.  Because he'd measured that one, I bought it to be sure the lid would fit.  So here's my future worm farm:

The shredded paper is for bedding for the worms.  I used duct tape to put a couple of layers of narrow flyscreen mesh over the hole.  Hopefully that will keep the mosquitoes out.  I'm also going to put in a couple of trowels of soil and some of the random brown stuff from my balcony, to give it more organic material.  And I'll soak it all before the worms go in.

I don't have the lid yet, he said I could probably pick it up tomorrow.  And I rang up the nursery, who said I could buy worms any day of the week :)

Meanwhile I've been collecting my kitchen waste in an icecream tub.  Not optimal, because it's rotting a bit, but oh well.  The worms can eat it later on.

Will post further on how it all goes!

Friday, 13 November 2009

Little sharp things...

Smith and I, changing lightbulbs.  Specifically, I bought them, he got up on a chair and put them in place, I reminded him to do so before the sun went down.

Then Smith says 'I think there might be something in my finger.'

Looked at his right index finger under the bright lights we'd just installed, and it was obvious there was something there, but it was tiny.  Tried to grasp it with my fingernails - definitely something hard there so not skin, but I couldn't grasp it.  Grabbed a pair of tweezers - still feeling the hard object, but no luck grasping it.

Now what?  Dig it out?  Me, who'd never dug anything out of skin before?  With no local anaesthetic?  Okay, well, I had pulled a 2cm "splinter" out of a man's foot before.  But that wasn't exactly hard.  This ... well.

The alternative?  No medical centres open.  Take him to the ED?   .... Err ... no.

No local anaesthetic in the house.  No sterile needles in the house - well, not your normal hollow ones anyway.  But I did have a sterile suture with a needle on the end of it, and it wasn't expired yet.  I was supposed to use it to practise suturing at some point (on a pork chop or something).  That, however, was years ago, and since then it was just clutter.  Might as well break it open.  There was supposedly a needle holder to go with it, but given the amount of clutter in my room, it was not to be found.

Slippery little J-curve needle had to be held one plane with my tweezers and supported in the plane with fingers.  The rest was no-touch technique and a little bit of scraping.

Smith, at one point, said 'That needle has some sharpness to it."  I took that to mean it hurt.  It turned out to mean that he actually didn't feel a thing.

End result:

That's it next to my fingernail.

A closer view:

The clear part was embedded right in the middle of the pad of his index finger.  The pink part is where the skin subsequently leaked a tiny bit of blood around it, I guess.

Will we wear gloves when changing light bulbs in future?

... Nah.

Friday, 14 August 2009

Letting go...

For a few months, I have been stewing over a hatchet job written about me, by someone I once (long ago, now) respected.

It is here. Yes, it laments the loss of a lot of things and the disappointment of many expectations. But she blames me.

She is not a stupid person. She is not without influence, either. As much as it was all old territory we'd been over many times before, I had food for thought.

Not that I responded, of course. But I considered it, a lot.

At 2am this morning I woke up to speak to a friend I had thought long lost. And I asked for, and was given, reassurance that yes ... the author of the above is completely delusional. The people who I still valued, the people who really mattered, have always been able to see what I truly meant and what I intended, and what effect it really had.

I still don't know how soon I will be able to get over it, though. My darned obsessional personality.

It seems this is a year for re-evaluating who I really am, from the outside in.

I am not just a precocious learner, I am not just the angel Jean, I am not just an Australian, I am not just a nerd, I am not just a doctor, I am not just a woman with a mental illness ...

And at the same time as discovering that I am more than the labels I have attached to myself, there are so many things I would like to be, that I may or may not become. Scientist, writer, lacemaker, musician, philanthropist, teacher, mother, champion ...

We will see. For now, I am just me.

Even I don't know who that is.

Tuesday, 28 July 2009

Small pleasures, small disappointments...

A single flower and some early buds in a plum tree...

A large magpie eyeing me warily as I walk by in a large green coat...

A crowd of people waiting at a train station, as the estimated time is blank...

Two trees full of large deep-red magnolias, half-open...

Wisps of steam from the building cooling tower...

The sun on my neck and the wind in my face as I walk between buildings...

Cement powder leaking from a pallet on a forklift rolling along, then piling up as he stops...

A friend's new hair colour which I would love to imitate, but would never dare...

... all reminding me that I'm still alive, as I take one day at a time.

Tuesday, 23 June 2009

In reply to: Denial...

Gah, I just wrote a long reply to my friend's blog post here, and then realised I'd written more than the original post... Time to copy paste.

Cam's original post deals with a workmate who had an affair with a married woman, and tries to justify it.

My reply:

Oh dear. Yes, I agree completely on both counts. Denial of the truth occurs on so many levels, ... although it is usually the complexity of the situation which allows denial, justification and moral dilemmas in the first place.

Although I would add a qualifier to your first statement: Denial seems to be a way for the guilty to remain sane without learning anything from the experience. Don't worry, Cam, once we give up the false shield of denial, we "guilty" don't necessarily go insane all the time! (Although hey, some of us already have.) I hold out hope that a person can learn something from each time they do something they know is wrong ... even if they only thing they learn is "I'll never do that again." And admitting and atoning for the wrongdoing? Well, that takes it a couple of steps further, although whether it helps is debatable.

As for marriage ... by goodness, people are so complicated and wrapped in their own little world of desires and attitudes. It should be established fact that trust and mutual support are the basis of a good marriage, but hey, nobody's done the randomised controlled trials. People like that man and woman obviously choose to believe otherwise, or at least act like it. And I guess there are other people who go along with society's norms without really thinking about it, so plenty of marriages hold.

But it takes a certain degree of empathy to think about a situation like this before it is actually upon you. To say to yourself that no, you wouldn't like it if you were in the husband's shoes. And it takes a bigger leap of empathy to decide that the husband deserves to have what you would want - unbroken trust in his wife. I have a feeling that that particular level of mutual 'thinking about each other' is the basis of most happy marriages.

That first step, of making people think about these situations? Hey, that's why we tell each other stories like this. That's why I keep reading this blog.

Hang in there, Cam.

Wednesday, 6 May 2009

The rest of my day...

Speaking of theory and practice, my attempts at writing concisely have obviously just failed me and it's past midnight. So here's a quick summary of what else happened today, without baggage:

I got my midterm assessment, and realised that I've been leaving my angel side with the patients and not with my colleagues;

I let myself get ambushed by tasks too many times, and missed out on a clinic and a lecture I would have loved to attend;

Smith and I went to dinner with some good friends, and met a friend's new girlfriend, who seems friendly and interesting and mature (and young, at the same time);

We all saw Mary and Max (Margaret and David review here), which has to be one of the best films I've ever seen, and claymation to boot.

More on each later, I guess. On that note, goodnight!

Tuesday, 5 May 2009

Theory and Practice

At 11am I was close to having an argument with a patient's granddaughter. At that point my registrar deflected the conversation, and I realised just how far I have to go in my communication skills.

Since I started university, for some reason I have considered myself to be an excellent face-to-face communicator. I knew I wasn't as good at writing, or at confrontation, but when it came to day-to-day interactions, it seemed to go more smoothly for me than for others. Now, I'm no charmer. I will never say anything just because it's what someone wants to hear. But by that token, people get to know that when I say something, I mean it. When I was young, I read a book about conflict resolution and active listening*, and so I try really hard to listen and understand people in return. And combined with the fact that I have a nice smile and (I thought) a good attentive manner, and my eagerness to say things in a way people will understand ...

... well, it seems to work. People like me. People smile at me when I smile at them. I have gone up to people and made bald-faced unusual requests, and had them granted out of the goodness of their hearts (in a good cause). And patients and their families love me.

Actually one of the positive thinking slogans I made for myself when I was down, was related to this: "The world smiles at me when I get things done and go out!" I really do have all the luck sometimes. I used that as my screensaver, so that when I got paralysed in front of a computer I might think about moving.

Being a doctor ... well, I certainly had a lot of skills to learn when I started - case presentation, handover, ward rounding, informed consent, explaining things to patients and their families. But it's been two years now, and these days I feel pretty confident, especially with the last one: explanations. I really put some thought into finding a simple way to explain what's happening and why we need to do certain things. But maybe I'm over-confident. It's come to the point where I do interrupt my registrar and at times even my consultant, in order to clarify things for the listener. Maybe I'm backing them up, or maybe I'm getting in the way and being inappropriate. I don't know how to tell.

Anyway, today ... we got a call to say the patient's granddaughter was upset and wanted to speak to us. Now, we hadn't met her before, but we were already having problems dealing with the patient's medical issues - mainly pain and agitation - and her son's distress. So on the way in we caught up with the nurse, who said the granddaughter's main concern was that the family hadn't been informed when the patient was moved into a windowless single room overnight. (Ahh, treatment rooms. Another story for another time.) And that the reason for this was that the patient had been agitated overnight, but now she was quite settled in the new room.

Now, we hadn't been informed either. Actually, we'd come in that morning and gone "where's the patient?" "Oh, she's on [a ward on another floor]". So I was all set up to go in and sympathise - after all, we would have preferred her not to be removed from her familiar environment either. But boy, did that conversation take a turn in the opposite direction.

She started by expressing her severe disappointment with the system, and her wish to speak to someone senior. Fair enough. We talked about the bed move, and the fact that yesterday she had specifically asked that the family be informed about any changes in treatment. Obviously that message and its scope (including 2am phone calls about bed moves) hadn't got through to us. Anyway, she thought her grandmother would have been further agitated by the move, and the language barrier wouldn't have helped, as her grandmother now didn't know where she was. I tried to explain that people had tried to speak to her in two of her native languages last night with no success - because she had been confused. She didn't agree.

But then she took a completely unexpected direction. She was concerned that her grandmother was drowsy, and expressed her opinion that she was on too much medication. At this point, I'm not sure, but I think I did no more than frown, I don't think I said anything. The response: "Don't question me." (I was standing facing her with my registrar between us half-facing her, so he couldn't see my face.) So I said nothing further, and she continued along her line - her grandmother was drowsy and not herself. Obviously this was true even if I didn't agree with her over the cause, and my facial expression at that point was (or should have been) of "concern". Suddenly her tone changed, and she looked like she was going to get angry with me. My registrar sensed it too, and quickly changed the subject slightly.

(As I later did manage to explain to her, we had cut her medications by two-thirds the day before, and she had had hardly any that night.)

Later in the conversation there was another flashpoint, where she had questioned the prescription of a medication a couple of nights before - the nurse had needed to tell the doctor a medication he was about to write had already been given. I tried to point out that the doctor was on the evening shift and wouldn't have known the full situation. She didn't respond well to that - she told me not to defend something that was wrong. (Later we pointed out that he had already asked for advice from a senior doctor before making that decision.) Anyway, I guess I scored myself another aggravation point with that one.

My registrar is a very experienced doctor, who worked in Palliative Care last term, and it's to his credit that he was able to defuse the whole situation. He acted swiftly to protect me from becoming a focus for her anger. Later, he explained that he could see her misinterpreting what I was saying, and he was afraid that she and I would get into a proper argument. Overall, his competence with the situation made me feel I should just keep my mouth shut and learn from the way he dealt with it. He did give me a few tips afterwards - on what parts of a conversation I should actively let go, and how to emphasize just the necessary facts.

It's funny, I always thought I was good with families. Now I realise that there are two categories I've learned to deal with. Anxious and worried people, I'm good at - I can give them enough information, and reassure them that I believe in what I'm doing. People who are just upset for no good reason and don't listen - I learned long ago that they're a lost cause. But there's at least one type that I don't respond to adequately - the angry argumentative person who listens to what I'm saying in the wrong way, and throws it back in my face. I get defensive, just like I tried to defend the intern from the other night. Those sorts of things, I need to learn to actively listen to, acknowledge, and then let go, and wait for the right time to provide correct information. And despite my reading, I've never practiced active listening and it's not in my skillset. More practice needed.

And there are probably myriad other situations I haven't yet come across or learned to deal with ...

Oh, and we did manage to explain everything to her in the end, and she agreed with the plan, and we encouraged her to take some of her concerns to a higher level. Later that afternoon, though, we were told she was planning legal action against the hospital.

*bibliography: I'm almost sure the book I read was We Can Work It Out, but it's way too recently printed... I've been trying to find which book I actually read. Any suggestions?

To begin with....

Way too much happened today.

So, in the interests of getting to bed before midnight, I'm going to change my posting style tonight. Instead of getting the whole train of thought, you get random passengers showing you their luggage. Then they get to go their separate ways, like they normally would.

Why? Well, I wonder sometimes about whether my essay style has too much of a wall-of-text effect. It's the only writing style I've ever trained myself to follow. In English class I started out being really poor at filling out each paragraph, but left to my own devices and topics it starts turning into lists, which can get really long. These days all I want to do is tell a story anyway.

Motley crew coming right up... possibly in chronological order...

Saturday, 18 April 2009

The Mentality of the Culicidae

It's 3am, and I'm awake. Again.

I used to be the type of person who would lie awake at night thinking about things. I have this goal of "understanding", so puzzling things out is a natural instinct. And hey, I used to have things to think about. The MUD, for instance. Why on earth did this player say that? Was that what he thought of me? Why would he think that, did they really think I was so selfish? How could I make them all see the person I really was? Et cetera. Or when I had a crush on a boy when I was fourteen, now, that really gave me something to think about. But that was long ago, and it's not why I'm awake tonight.

No, tonight there's a mosquito in my bedroom. Again.

Now, I like to think of myself as a nature-lover. Some of my fondest childhood memories are of visiting the Botanical Gardens with my family, being taught about the different trees and flowers, feeding the ducks. When I was lonely in primary school, there was a patch of buttercups far across the field from where everyone played, and I would retreat there when the age difference got too intrusive for me, and keep the bees company. And I like cute and cuddly animals as much as the next girl.

Actually, I've probably quite a bit more tolerance for the wildlife than your average person; too much David Attenborough as a teenager, I suppose. (No, you can never watch too much David Attenborough.) So, in accordance with his enthusiastic attitude, I find it all interesting, curious and worth preserving (although I haven't gone vegetarian). This means that I don't mind large spiders, because the big ones we get here are harmless; in a safe environment, I wouldn''t mind handling a snake. To me, ants' nests are a marvel of nature, as you can see in this video, although obviously they're best left alone. I like earthworms, in theory, although I've never bothered digging them up to go look at them. By a weird extension, I like colorectal surgery. (Seeing the patient's innards spread out on view... Pink and wriggly? Happy guts. Ooh, that bit looks sick, poor thing. Let's cut it out. The rest of them still happy? Happy guts.)

But well, mosquitoes are the lone exception. They spread malaria, causing a worldwide disease burden. Not to mention myriad other diseases. They don't support any ecosystem, as far as I know, because they're a pest feeding on humans and animals. They seek me and my mother and sister out preferentially, and we get huge welts that last for days and sting at night. I don't believe in "evil" in the malignant, people-hating sense, but ... mosquitoes are the enemy and must die.

Which brings us to The Hunt.

The door is closed. The lights are on. All wooden surfaces get checked. Then Smith gets covered in blankets up to his face, and my arms and head are free to act as bait ... and to smack them out of the air. I used to be reasonably good at it. When I was on rotation on the North Coast, in a house with broken fly-screens, I'd sit for an hour before bed and get about six or seven of them each night. Then I could sleep knowing that with the door shut, no more would come in.

These days, though ... I don't know what it is. Maybe I'm older and slower. Maybe I'm tired more often. Maybe the mosquitoes are faster, where we live now. But many hours over many nights have been fruitless, and I usually end up just putting a blindfold on and going to sleep with the lights on. I don't think I've caught a mosquito this year, and there have been plenty.

So I've had plenty of time to think about the intelligence of the mosquito. Obviously it's not on a par with the human mind. I must be some kind of animist, because I usually like to think of things as having a personality - trees, germs, guts (as above), supermarket trolleys, you name it. But well, I don't even like to dignify a mosquito by giving it its proper gender (only the female ones bite). No, this is not your average gravid female looking for nourishment for her eggs, and this is not a bitch-slap fest. It is an IT. Kill it.

There used to be a catchy television advertisement for insect spray, that featured an anthropomorphic, singing housefly. I'm Louie the fly, Louie the fly, straight from rubbish tip to you! Spreading disease, with the greatest of ease ... But when you're in a room with a mosquito ... well, it's not exactly a planning genius.

"Right, we go around the bedpost here and between the slats, and they'll be straight ahead. Ignore the golden-haired one, the Asian one has a better blood group, taste that carbon dioxide on her breath ... So we're going to zoom over the face, we don't want her to wake up, focus on the hands, arms, anything but the head, you got me? And do not, I repeat, DO NOT land on the hair - it's a trap. They're not called hair triggers for nothing. Okay, you ready?"

No, I like to think of a mosquito more as a machine. In its nervous system and what counts for a brain, it has, what, ten thousand neurones? A hundred thousand? I don't really have a clue, although I bet it's not in the billions. And there are probably only a few basic impulses - eat, mate, hide. Each one would have excitatory and inhibitory factors, and you can kind of predict what they are.

Anyone who's done neuroscience probably knows what I mean by that, but here's an analogy. Mating aside, let's say that 'hide' and 'feed' are at opposite ends of a dial. What the mosquito does depends on where the dial is at a particular time, and that depends on the environment. The time of day is one factor pushing the dial towards one end or another - feeding at dawn or dusk, and hiding the rest of the day. The presence of food pushes it towards feeding - I've just looked it up, and apparently carbon dioxide and oct-1-en-3-ol in breath and sweat are strong attractants. I used to watch them come up to me, mesmerised, tracking along the trail of my breath - conveniently, right in front of my face so I could smack them between my hands.

Obviously being swatted at is a fast swing towards the "life-preservation" end of the dial, but also, the presence of a good place to hide will attract it. I've learned that mosquitoes like to hide on dark wood-grain surfaces, and I used to be able to go hunt them down on my bedroom door or the bookshelf. (Now my bed is wooden and there's an underneath for them to hide. Grr.) And, to my despair, having the light on (so I can see it!) seems to be a strong push towards the 'go hide' end. Maybe having a 35 watt fluorescent for sewing and reading as the top light (100W incandescent equivalent) wasn't such a good idea.

Other than that, I'm guessing. I suspect that while light is a fast swing to the hiding end, darkness is only a slow push in the other direction. I wonder if the strength of the light is a factor in the speed. Sometimes I wonder if they're tempted to hide on my hair, being a dark, grainy surface. I haven't yet gone as far as digging out my tiny stash of acupuncture pins and opening a vein to attract it despite the light, but tonight I'm tempted. It did come out when I had a nosebleed earlier tonight, after all.

That only accounts for about fifty neurones in total, so obviously a mosquito is more complicated than that. But I've got a hundred billion ... I win, right? Well, that's what I'm hoping...

neeed ... sleeeep.....

Tuesday, 13 January 2009

People will forget what you said
People will forget what you did
But people will never forget how you made them feel.

Maya Angelou

Of course, this is true even when people have completely misunderstood what you said and don't know what you did.