Sometimes when you have a health issue it can take a long time to tease out exactly what is responsible for your presenting symptoms. In my own case this applies to the debilitating post-viral fatigue that I developed after a trek in Nepal in late 2011.
The jury is still out, but I have already been assessed by three departments of one of our major teaching hospitals, including Infectious Diseases, Haematology and Neurology.
Many of my appointments have involved the customary long wait in the Outpatients Department along with a herd of other people. I think at worst this has been about three hours. On this occasion one saintly staff member started bringing around cups of water to the waiting crowd.
We are lucky to have a fine public hospital system in Australia that gives people access to the specialist care that they could not otherwise afford, but it is a pity that there does not seem to be any antidote to either the lengthy delay in scheduling of appointments or the crowded and slow-moving waiting rooms. Despite these trying circumstances, people are generally still very resigned, patient and polite and remain grateful for the attention they receive. We are conditioned to accept that it "is what it is" in terms of waiting for healthcare, whether it is at the GP or in the Emergency Department or Outpatients.
However, I digress. For my neurological symptoms I was fortunate to see an experienced consultant whom I knew of by reputation. In addition to blood tests I was scheduled for a Neurophysiology nerve conduction study and two MRI scans (brain and lumbar spine). There was a little bit of a wait on the day of the nerve conduction study and I was a little concerned whether I would get back to my car within the two-hour parking limit but fortunately I got back with about five minutes to spare. The study itself was an interesting experience. I had used a nerve stimulator on other people during anaesthetics training and had tried a TENS machine on myself, so initially it was quite similar to this, with electrodes being attached to my skin and conduction being measured with electrical stimulation, both before and after "exercise". As my muscles were getting fatigued with exertion, I had assumed this aspect would involve at least moderate exertion of a reasonable duration, but this was a faulty assumption. This component involved only a small number of repetitions of almost minimal movement e.g., opening and closing your thumb. The second aspect involved the insertion of fine needles under the skin, identifying pairs of nerves and measuring conduction. This caused a little bit of bleeding in my forehead so pressure had to be applied to prevent a haematoma and bruising. I was quite surprised that this area was exquisitely tender for about ten days afterwards.
My first MRI (brain) was in the public section of the hospital. Once again I did not have to wait too long to be called through. After changing into a hospital gown there was a little bit more of a wait before one of the nurses inserted an IV cannula in my arm (for administration of contrast) and went through the safety checklist. The cannula took two attempts but we had a nice conversation, and I was asked several times if I was warm enough. I was given some headphones to listen to music during the MRI scan (rather loud and bombastic classical music unfortunately) and was again asked several times during the scan if everything was OK. There were lots of loud noises, clicks, whirring and even some vibrating from the scanner, but time passed quickly enough. I can see why some people might feel claustrophobic in the small narrow tunnel, but I just closed my eyes and tried to assume as meditative a state as possible, and all was fine.
The second MRI (lumbar spine) was in the private section of the same hospital one evening. This time it was a long wait for the scan and in the holding bay before the scan, but the staff was attentive and caring. I had a 7pm appointment and left at 9pm.
My outpatients appointment was on 22 March, but the day before the second MRI I received an unexpected letter advising me of an appointment for a third MRI on 9th April. I queried this at my second appointment, and was advised that there had in fact been three MRIs requested (brain, lumbar spine and cervical spine), but this had only just been realized so a third scan had been booked. I was concerned that this booking took place after my outpatients appointment (for which I had already been waiting several months) had been scheduled. In the end I was just told “sorry, we can’t make it any earlier”. I then contacted Outpatients, and asked for an early appointment after my third MRI scan. It was a case of “sorry, the earliest is 10th May”. A few weeks later I received a letter advising me (without explanation) that the appointment had been moved to the 25th of May, which was two months after my previous appointment.
I will now be having the review of my blood tests and investigations six months after my initial appointment with the neurologist. It will then be over eighteen months since I first attended the hospital seeking a diagnosis for my post-viral fatigue.
I have gone through this process to date the same as any other person, without any special favours due to my vocation. This first-hand view of a compartmentalized and overstretched system is not reassuring in terms of the health care of the average person without the benefit of medical training to assuage their fears. On an individual level, everyone is doing their job and doing it well (with the exception of failing to book a third scan around the same time as the other two) and as is so often the case it is perhaps systemic issues that need to be addressed. Surely we can do better. It would be interesting to know how often logisticians and systems analysts have been included in review teams focusing on how to make our health services function more efficiently.
Thursday, April 4, 2013
Lilyhammer - What a cracker!
This is a new must-see TV series showing on SBS on Saturday nights. It is the improbable story of Frank "The Fixer" Tagliani, a New York gangster who turns Crown witness and goes into witness protection in Lillehammer, Norway after falling in love with the place during the 1994 Winter Olympics. As Giovanni "Johnny" Henriksen he lives in a humble abode next door to the Chief of Police and drives an electric car. He is often seen out and about wearing headphones in an effort to learn Norwegian.
Right from his arrival in Norway we start to see why he is called "The Fixer". He rights wrongs perpetrated by youths on the train and already makes some useful alliances. Proving himself to be a gangster with a heart of gold, he saves a wandering sheep, takes a posse out to kill a marauding wolf which later killed the aforesaid sheep (despite the group being warned off by the Chief of Police) and explores "cultural differences" with the local public servant in the employment agency, using some naughty photos found in a local cabin as persuasion to do a favour for the mother of the boy who lost his sheep and to help him get a bar licence (previously "too complicated").
He seems quite keen on Sigrid, the single mother, in a gentlemanly sort of way, so it will be interesting to see where this leads.
The language effortlessly shifts from English to Norwegian and back again (sub-titles are supplied) and this is really no impediment to understanding. For the most part, the Norwegian is clearly spoken and it is possible to pick up a reasonable amount of the meaning if you have an everyday knowledge of the language. There is a little bit of low-level swearing in both languages but not enough to be offensive.
Having lived in Norway and experienced the scenery, climate and culture it is just hilarious at times to see Johnny challenging the law-abiding status quo and appealing to the rebel within. He gets things done in a way that looks after "the little people" and protects the disenfranchised and vulnerable.
Steven Van Zandt is perfect as the gangster, reprising a similar role that he played in the Sopranos, and he is also a writer, producer and music consultant for the series (also being a long-time Bruce Springsteen band member). The Norwegian cast members are very believable as ordinary small-town citizens.
It has been a very promising start and well worth continued viewing. There were two very good reviews of the series in "The Age" recently, including a feature article in the "Green Guide". Both gave it a good rating.
Right from his arrival in Norway we start to see why he is called "The Fixer". He rights wrongs perpetrated by youths on the train and already makes some useful alliances. Proving himself to be a gangster with a heart of gold, he saves a wandering sheep, takes a posse out to kill a marauding wolf which later killed the aforesaid sheep (despite the group being warned off by the Chief of Police) and explores "cultural differences" with the local public servant in the employment agency, using some naughty photos found in a local cabin as persuasion to do a favour for the mother of the boy who lost his sheep and to help him get a bar licence (previously "too complicated").
He seems quite keen on Sigrid, the single mother, in a gentlemanly sort of way, so it will be interesting to see where this leads.
The language effortlessly shifts from English to Norwegian and back again (sub-titles are supplied) and this is really no impediment to understanding. For the most part, the Norwegian is clearly spoken and it is possible to pick up a reasonable amount of the meaning if you have an everyday knowledge of the language. There is a little bit of low-level swearing in both languages but not enough to be offensive.
Having lived in Norway and experienced the scenery, climate and culture it is just hilarious at times to see Johnny challenging the law-abiding status quo and appealing to the rebel within. He gets things done in a way that looks after "the little people" and protects the disenfranchised and vulnerable.
Steven Van Zandt is perfect as the gangster, reprising a similar role that he played in the Sopranos, and he is also a writer, producer and music consultant for the series (also being a long-time Bruce Springsteen band member). The Norwegian cast members are very believable as ordinary small-town citizens.
It has been a very promising start and well worth continued viewing. There were two very good reviews of the series in "The Age" recently, including a feature article in the "Green Guide". Both gave it a good rating.
Electricity saving tips!
If you don't use your wall oven (whether electric or gas) on a daily basis, then consider turning the power off at the wall (or the switchboard as applicable) when it is not in use. Turing off this redundant wall clock appears to have made a noticeable difference to the power bill for the last quarter.
Turn off your microwave and any other appliances with a digital display when not in use. Also consider turning off your digital alarm clock and door bell during the day when you are not at home.
Replace any power boards which have a standby light which is on even when none of the power points are being used.
Being known as "Doctor Gadget" I also have a range of solar charging gizmos which can be used for charging your mobile phone and other small appliances. However, the only problem with this is that it is quite difficult to get them fully charged unless direct sunlight is falling on them regularly, so this isn't a regular option unless you have somewhere suitable and safe to leave them during the day. It is also something more likely to be successful during the summer months. However, even if it is only the occasional charge it will still be a small contribution to reducing your power bill.
Migraine Attack - How are the mighty fallen!
After successfully enduring the rigors of standing and singing for the four major Easter services on Holy Thursday, Good Friday x 2, Easter Vigil and Easter Sunday, I was laid low on Easter Monday with a massive migraine. I felt a few 'niggles' of a headache before going to bed tired on Sunday evening, but took some simple analgesia and thought nothing more of it. The migraine crept upon me in the early hours of Monday morning, and I tried all the usual simple remedies - a hot pack to the neck, simple analgesia, anti-emetics and caffeine, but to no avail. The waves of nausea sweeping over me became more and more insistent, and in the end I had no choice but to succumb. I was amazed at the amount of liquid that issued forth, and had to conclude that the migraine had brought on a case of gastric stasis and that everything I had drunk during the morning had gone no further than my stomach. As usual, I felt much better after vomiting and was able eventually to go on and retain an anti-emetic and a prescribed migraine tablet (usually kept as a "last resort" due to the cost per tablet). Although I was now feeling a bit better, I was quite listless. I had no energy to do anything, could not read due to blurry central vision and kept wanting to doze off whilst watching an otherwise interesting documentary on the "Curiosity" Mars Rover. In the end I just continued resting in bed. Fortunately I was able to eat a light evening meal and went to bed early, sleeping for over nine hours. In the morning the headache was thankfully virtually gone, with just residual muscle stiffness and soreness remaining. As I was still somewhat bereft of energy it was lucky that there is a break from teaching this week and I can just work at home.
Migraines run in the family, so I was perhaps doomed from the start, but I still remember the first migraine I ever had at age 13 - I woke up in the middle of the night and felt as if someone was digging an ice-pick into the side of my head. Sometimes I get auras (kaleidoscopic geometric patterns moving across my visual field in an expanding crescent shape) or blurry central vision with or without a headache, and sometimes I don't. Whatever the story, it is always enervating and leaves you feeling guilty about lost time.
It is worth noting that the Skins compression garments certainly helped me to stand up for lengthy periods and reduced the stiffness in my legs but I wonder if the top section, although helpful for my back, was counter-productive for my neck and shoulders and in retrospect it was perhaps a mistake to keep wearing it overnight.
Migraines run in the family, so I was perhaps doomed from the start, but I still remember the first migraine I ever had at age 13 - I woke up in the middle of the night and felt as if someone was digging an ice-pick into the side of my head. Sometimes I get auras (kaleidoscopic geometric patterns moving across my visual field in an expanding crescent shape) or blurry central vision with or without a headache, and sometimes I don't. Whatever the story, it is always enervating and leaves you feeling guilty about lost time.
It is worth noting that the Skins compression garments certainly helped me to stand up for lengthy periods and reduced the stiffness in my legs but I wonder if the top section, although helpful for my back, was counter-productive for my neck and shoulders and in retrospect it was perhaps a mistake to keep wearing it overnight.
Veni sancti spiritus!
On Sunday 31 March I was as usual part of the choir at St Francis' Church, Lonsdale Street, Melbourne for the Easter Sunday 11:00 mass and we were standing in the back of the sanctuary behind the altar and the celebrant. While the celebrant was reading the Gospel one of the servers was standing to the left of the lecturn, waving the thurible back and forth, with a steady cloud of incense rising upwards. Something unusual caught my eye as a perfect ring of white smoke also emanated from the thurible. With a thick rim, it quickly became more square than round and then as it passed the celebrant and the right hand side of the lecturn it formed into a perfectly symmetrical dove, complete with wings, head and beak, and then slowly dissipated as it passed towards the front row of pews on the right hand side of the church with two shiny wing edges remaining visible until it was gone.
In Christian faith the dove is the symbol of the Holy Spirit, the third member of the Holy Trinity, and I felt as if I had seen the Holy Spirit that morning. Somewhat prophetically, the following sermon was about keeping your faith, even in times of doubt. With all the trials and tribulations in life set in a rationalistic (and some might even say atheistic) age keeping faith can be a daily struggle when your soul is sorrowful and burdened. I want to believe but I would be lying to say that there are no doubts. However, seeing that white smoky dove in that precise place at that precise moment on Easter Sunday brought some tears to the eyes of a weary soul and it was if for those few seconds the Holy Spirit made it plain that it walks amongst us and that we can dare to keep faith in hope and the message of the resurrection story.
In Christian faith the dove is the symbol of the Holy Spirit, the third member of the Holy Trinity, and I felt as if I had seen the Holy Spirit that morning. Somewhat prophetically, the following sermon was about keeping your faith, even in times of doubt. With all the trials and tribulations in life set in a rationalistic (and some might even say atheistic) age keeping faith can be a daily struggle when your soul is sorrowful and burdened. I want to believe but I would be lying to say that there are no doubts. However, seeing that white smoky dove in that precise place at that precise moment on Easter Sunday brought some tears to the eyes of a weary soul and it was if for those few seconds the Holy Spirit made it plain that it walks amongst us and that we can dare to keep faith in hope and the message of the resurrection story.
Blackout - Life but not as we know it!
A week ago I had one of those wonderful retrospective experiences that reminds you just how dependent we are on technology.
Following the uplifting experience of singing at the Holy Thursday evening service, I returned homw looking forward to a hot meal and catching up on a few interesting shows on TV that I don't normally get to see on Thursday night due to choir practice.
The first sign that something was wrong was that the security light outside the front door did not go on. Already I was wondering if the power was off. Opening the front door confirmed this. No electricity and the main circuit breaker was still on. However, some of the adjacent properties appeared to have normal lighting and the street lights were on, so what was happening?
Like Boy Scouts, Ski Patrollers always aim to be well prepared, so with the aid of a trusty solar-powered torch candles and matches were rapidly located and lit.
However, things were looking a little grim. With no power, there was no telephone, no kettle, no stove and an overriding imperative to keep the refrigerator shut!
Following the uplifting experience of singing at the Holy Thursday evening service, I returned homw looking forward to a hot meal and catching up on a few interesting shows on TV that I don't normally get to see on Thursday night due to choir practice.
The first sign that something was wrong was that the security light outside the front door did not go on. Already I was wondering if the power was off. Opening the front door confirmed this. No electricity and the main circuit breaker was still on. However, some of the adjacent properties appeared to have normal lighting and the street lights were on, so what was happening?
Like Boy Scouts, Ski Patrollers always aim to be well prepared, so with the aid of a trusty solar-powered torch candles and matches were rapidly located and lit.
However, things were looking a little grim. With no power, there was no telephone, no kettle, no stove and an overriding imperative to keep the refrigerator shut!
The good old mobile telephone saved the day as a means of contacting the power company, who promised to dispatch a truck.
Waiting was frustrating. It was too dark to read or to do any household tasks, no radio or music to listen to and dinner was definitely on hold.
It was fascinating to reflect that this was how our forebears lived until the advent of electrical power. I guess they didn't know any other way of living, and I suppose that we could adapt to it if we had to, but it certainly underlined how much we take our everyday tech nological aids for granted.
When you visit any outdoor activity and camping store, it is equally amazing just how many devices and pieces of equipment there are to help bring along the luxuries of home. Good old-fashioned simple camping with a gas stove, torch and mosquito net seems to have gone the way of the dinosaur!
Fortunately the repair truck arrived sooner rather than later, and it turned out that just a couple of wires on one of the power poles in the street had shorted out, only affecting a small number of properties. Soon all was back to normal, with power, light and hot food.
It only occurred to me later that it was not only our forebears who lived in a world bereft of power and conveniences - many people in the developing world are still in this situation. It is easy to forget how lucky we are that we happened to be born into a progressive Western society. It is the only life that we know, but we also know that we do not wish to live as they do, and in our hearts we understand why others might aspire to come here and live as we do.
This should persuade us all to be humanitarians, to do unto others as we would have done unto us. We might not be able to solve the problems of the developing world, but we can all do what we can to improve the quality of life for the other people who share the fragile spaceship Planet Earth. It doesn't cost anything to be nice and to "pay it forward".
Waiting was frustrating. It was too dark to read or to do any household tasks, no radio or music to listen to and dinner was definitely on hold.
It was fascinating to reflect that this was how our forebears lived until the advent of electrical power. I guess they didn't know any other way of living, and I suppose that we could adapt to it if we had to, but it certainly underlined how much we take our everyday tech nological aids for granted.
When you visit any outdoor activity and camping store, it is equally amazing just how many devices and pieces of equipment there are to help bring along the luxuries of home. Good old-fashioned simple camping with a gas stove, torch and mosquito net seems to have gone the way of the dinosaur!
Fortunately the repair truck arrived sooner rather than later, and it turned out that just a couple of wires on one of the power poles in the street had shorted out, only affecting a small number of properties. Soon all was back to normal, with power, light and hot food.
It only occurred to me later that it was not only our forebears who lived in a world bereft of power and conveniences - many people in the developing world are still in this situation. It is easy to forget how lucky we are that we happened to be born into a progressive Western society. It is the only life that we know, but we also know that we do not wish to live as they do, and in our hearts we understand why others might aspire to come here and live as we do.
This should persuade us all to be humanitarians, to do unto others as we would have done unto us. We might not be able to solve the problems of the developing world, but we can all do what we can to improve the quality of life for the other people who share the fragile spaceship Planet Earth. It doesn't cost anything to be nice and to "pay it forward".
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