Oncology clinic

Thursday afternoons are the part of my week that I both look forward to and dread.

It takes a very special person to want to be an oncologist. I am not that special.

My friends ask me how I deal with the constant flow of sick people and misery and pain. I have a little secret to tell you: it's not always like that. My days are full of people finding something that makes them smile, of people having ordinary problems like being a little constipated or hating red jello. And I like people, generally.

Surgery is fantastic because you get to see people come in sick, get operated, and get better. They go home and maybe a month later you see them in clinic looking like a rock star.

But now I'm doing clinics and in their infinite wisdom (and the fact that I didn't know what to choose so I left it up to my school) the powers that be have decided to plunk me into medical oncology clinic.

Now I am dealing with a constant flow of sickness and misery and pain and fear and the unknown and side-effects....

A young man who has had a complicated course with Ewing sarcoma and who had eventually decided not to have any more surgery or chemotherapy came to see us for follow-up. He had been pursuing several holistic therapies, and he felt that these were helping. Though he was having some pain, he chose not to speak to the palliative care team, because he was not ready to accept 'palliative care,' end-of-life care, terminal care, whatever you want to call it. He pushed for a follow-up CT scan to see whether his tumours were actually getting smaller. The oncologist did not want to do the scan, but to just follow-up clinically. But he did the scan because the patient wanted it.

And it showed the tumours growing. A lot.

The patient was terribly disappointed. He is now having more pain. He is panicking at night when he is alone. He is asking us about the possibility of more surgery, which of course at this point would be of more harm than good. He finally realises that this cancer is going to kill him, and soon.

Finally, now, he has decided that palliative care might be a good idea. They are a good idea. These are people who have put the art back into medicine. They are a group of people who take whole-person care to heart, and will talk to a patient about his fears of dying, about what his hopes are for the remainder of his life, and for those he will leave behind. They have also taken the science of pain control to a whole new level.

For simple people like me, this is hard.

Everyday or Madman?

Anagram genius may just reveal something about you.

To those who know me, that the above is an anagram of my name will come as no surprise. Oh, minutes of fun.

I'm not a doctor but I play one on TV

Trust the Brits to do something like this: *scientific proof* that surgeons are hot!

Gotta love it.

**OK, it's a joke, but told well.

A Madonna

Just reading one of my favourite blogs, by Fat Doctor, which is a thoughtful and often very personal look at life from the point of view of a beautiful and sensitive soul who happens to be a doctor.

She was talking about her desire for another child and her despair at China's new and restrictive rules on just how perfect you have to be to become an adoptive parent.

Someone in the comments section jokingly suggested "pulling a Madonna," and I wanted to comment without taking over, because of my own recent experience.

I met two azungu (white) families who had adopted Malawian children. They can attest that the government don't make it easy, and the reception by local people is not always warm.

There are about 900 000 orphans in Malawi, a country of only 13 million people. Given that fact, you could be forgiven for thinking that the government and people of Malawi would welcome families from abroad looking to adopt a child. So why isn't this the case?

I put this question to a woman who has worked in Malawi for the past eight years. She pointed out what should have been obvious: how orphaned children are regarded in Malawian culture.

It is true that there is normally a social safety net, that children would be taken in by their extended family.

What is not generally said is that these children are often not raised "as one of our own," but are used as a form of cheap domestic labour. As in any society, these children are vulnerable to sexual and physical abuse. They are unlikely to be sent to school. They are treated as workhorses.

So what would a white family want with an African child?

It seems unlikely in a place where resources are so very scarce that this child will be a cherished one, given the best that the adoptive parents can afford in terms of education and food and clothing.... it seems unlikely that this child will be coming into a loving environment. It becomes much more believeable that these children will be exploited.

Child labour.

Trade in human organs.

Witchcraft.

The list of incredible and distasteful rumours goes on.

Snow Problem

It appears that we Montrealers got used to the idea that this winter wasn't playing by the rules. Currently listening to the traffic reports, and it sounds like we have forgotten how to drive in snow!!

So ashamed.

Missing Malawi today. Walked home in the snow. Not entirely looking forward to digging my car out by Wednesday (due to the impenetrable parking laws that only living here for a decade or more gets you to the point where you can begin to not get parking tickets, I have to move my car by then or get ticketed).

Still, how beautiful is my city?

And how lucky am I ?

I have the perfect solution to this weather.....



Stay in.... blog.... write papers...... drink hot chocolate...... study....... in front of a roaring fire.....



Update: The radio announcer just said the words "Gong Show" in the context of traffic reports. That's generally not good news, is it?

Distraction

Read this.

My school was worried about me going to Africa and putting myself at risk, but the truth is, it could as easily happen here. In Montreal we don't, for example, use the self-sheathing syringes he cites as a great improvement, we use the old-fashioned and appreciably cheaper sort that they also use in the UK.

In Malawi, we had the other type. Due to the perception of the risk, no doubt. I liked them.

Coming home

Funny to think that I just came back from Africa and if I went to hospital with gastro, the docs would have thought I'd brought it home with me.

But now the hospitals are being hit hard by Norwalk. Not to mention our beloved Montreal Canadiens.

Me, I'm back in the classroom and so am missing out on this one.

Too true

You Are the Swedish Chef

"Bork! Bork! Bork!" You're happy and energetic - with borderline manic tendencies. No one really gets you. And frankly, you don't even get you. But you sure can whip up a great chocolate mousse!

The Muppet Personality Test

Check it out! Found whils giggling at Mr. Hassle's Long Underwear by Doc Shazam.

Waiting to Exhale

Which could be a reference to my failed attempt at scuba diving on Christmas Eve. Probably doable but not much fun when you are the only one in the group who doesn't speak Danish and therefore you have nobody to giggle and be a moron with. Breathing underwater is not obvious. Next time.

In actual fact refers to the currently waiting and living in limbo state of getting ready for/doing interviews which will decide the trajectory of my life. Questioning the wisdom of throwing myself wholeheartedly into my hope of becoming a surgeon rather than hedging my bets like most of my class did, applying to a specialty but also a second choice 'just in case.'

I figured any second choice programme would look at my record and laugh their heads off, it's so obvious I want to do surgery.

Still, if I chewed my fingernails, I'd probably be heading for the elbows by now. Wish me luck.

Oh and What a Time

Well, I hope you had a Merry Generic Holiday Season and all that other politically correct stuff.

Imagine, if you will, something more out of place than an Evangelical Atheist in an African Baptist Church on Christmas Day with a load of International Faithful Folks and an African American preacher from Mississippi or Tennessee or somewhere where they really do say things like "Can I get an AMEN!!!"

I was looking for the hidden cameras.

*****
This is what a Christmas tree looks like in Embangweni, a little town in Northern Malawi where the language is different but similar (-Muli uli? -Ndili makola, kwali imwe?).

I haven't had a Christmas tree in years, something to do with being a cynical atheist who hates all the commercialism that has taken over some beautiful old pagan traditions. And a bit of a Scrooge (bah, humbug) as well.

But I found decorating this one in Malawi oddly comforting. Thanks for sharing it with me, Martha.

*******
Christmas coincides with malaria season. Love that mefloquine. No problems this time. Gotta say, it really helps to take it in the morning or at least with meals to avoid the terrible heartburn.

Love that mozzie net. Because:

1. It is BLUE.
2. It keeps the little buggers from whining in your ears which is possibly the most annoying thing in the world.
3. It also keeps out cockroaches, mice, snakes, and other assorted things you don't want to be thinking about whilst trying to sleep.
4. It is impregnated with permethrin which kills off anything creepy-crawly which happens to creepy-crawl over it.
5. Did I mention the whole BLUE thing?
6. Oh yeah, three years, Elephant Marsh, Mulanje foothills, Lake Malawi, you name it and NO MALARIA.

*********
If you look REALLY CLOSELY, you should just about be able to make out what the sign in the minibus' rear window says.

And to answer the question:

• There will be 23 people at least in this Hiace
• I could tell you how fast they go but you wouldn't believe me. It doesn't seem scientifically possible for such a small engine to pull that much weight at these speeds. But as my old friend Dirk used to charmingly comment on such things: "Science stops at the equator."
• Traffic accidents are deadlier than any tropical disease.

******
This was the view I woke to on Christmas Day. Lake Malawi, Nkhata Bay, rainy season.

Mayoka Village.