With Love, Deutschy

Dear All,

Medicine is in an uncomfortable, nascent stage. None of us like to admit it, but we do not practice evidence based medicine. At times we practice intuition or logic but not in any sort of systematic manner. We deal with our patients’ problems intellectually the way a tradesman does, rather than an engineer. This despite our training, despite advances in statistics, computational biology, bioinformatics, engineering and a multitude of other disciplines.

Why is this? I think part of it is the idea that if we take away the mystery then we are no longer magicians. We are just ordinary people performing unusual but mundane things, but in a top hat and tails.

Ideas often develop such:

• Theory A explains some of reality.
• Theory B dissents against theory A’s incomplete explanation and invokes a reactionary theory that revolves around the opposite idea. However, this theory is also incomplete.
• People realise that both theories have their merits and combine them into an integrated Theory C.

Currently in medicine we can say that “treating patients based on experience and intuition as all patients are unique” is Theory A. Evidence based medicine evolved out of a need to standardise care and base it on some sort of empirical science- a lot of “intuitive” ideas were total crap (e.g. bleeding people for no good reason). So what is Theory C? Well the problem of course is that all patients are different however we need to validate their therapy based on science. So perhaps it is what oncologists and infectious diseases specialists are doing now- tailoring medicine according to genetics, gene expression and other patient/disease specific characteristics.

However, there are problems with this approach too. Another theory will react to the first. Eventually Theory E will supplant them both.

While this is all lovely, unfortunately we are still stuck with scientists in either Theory B or C and most clinicians back at Theory A (some at Theory B and occasionally a Theory C- most but not all are physicians).

Progress is slow, and understandably no-one wants to “gamble” any sort of unproven “new” approach on their patients at first, I suppose.

Yours,

Deutschy, now complete with casino carriage!

Dear All,

I have been working on this one for some time.

You can think of the spectrum from pathophysiology to disease to symptomatology to be roughly as follows:

Root causes

Pathophysiology

Organ-specific disease

Signs

Symptoms

(As if layers on a cake)

We often concentrate, in clinical medicine on a small selection of these, often closer to the bottom. However, a lot of things are both easier to remember and make more sense when clustered into related and overlapping topics, or seen in terms of multi-organ disease.

A small handbook that gives a concise, visual reference would be helpful.

Ideally, it would be nice to have a computational biologist involved in order to define accurate (and often startling) relationships between various conditions- (to take a banal example, smoking is an independent risk factor for developing diabetes).

Yours,

Deutschy, organically developing our rail network!

Dear All,

For various reasons, this blog will cease to be personal, but rather be more about what it was originally meant to be- ie an “ideas” blog.

Yours,

Deutschy.

Dear All,

At first sight this seems innocuous. Until you remember that most of this "pride" was the imagery used after the Cronulla riots. Using the Australian flag as an Anglo nationalist "white pride" symbol.

What kind of country do I live in? One where people tattoo themselves and use the Australian flag in ways analogous to neo-Nazism? Where it is routine for our "heroes" (muscled sports players) to rape women in packs as a stylised symbol of masculine power? Where the mentally ill, non-English speaking, indigenous or disabled are routinely discriminated against in the hospital setting in terms of decision making and access to intervention? Where there is always the fear that you will be the next target of violence from young, spoilt, drunk, privileged "adults" who are "empowered" by their knowledge of martial arts or their strength in numbers.

Believe me, this is already an improvement after Howard left power. But there is an entire generation and a half who grew up in his shadow who spout some scary shit on a daily basis.

It is scary and disturbing.

I do not know if I want to be here in 20 years.

Deutschy

Dear All,

Four hours ante meridian is that hour where you start to realise it is only 2 hours before the sun comes up. It is a netherland between day and night. After the pubs are shut but before the bakeries are open. Nothing is going on (except somewhere else in the world).

Something blurs in your head. You are more susceptible to ... everything. Those dangerous, insidious, dark ideas and thoughts and words bubble to the surface - yours and others'. Your very presence is liminal.

You are never quite clean at this hour. Even after a shower you feel dirty, unshaven, grimy. Noises are noisier. The hum of the computer becomes a background drone. Things become a very regular, hyperacute continuity, but it is as if you are seeing this augmented reality from afar.

It is the time we make the best and most dangerous things. The most truthful and rewarding revelations. The most shocking mistakes. The most ambivalent decisions.

Alone, but not lonely. Stealthy hunters in the night.

Yours,
Deutschy.

Dear All,

Anyone noticed how there is not a single non-white person on Neighbours except for an extremely stereotypical "Asian exchange student"? No Vietnamese, Sri Lankan, Indian, Singaporean, Chinese, Lebanese, Sudanese characters.

For that matter, not even any Greek or Italian characters! This is apparently meant to be a show set in Melbourne, one of the most multicultural places in the world! I very much doubt you could find a single street like in this fictional "Erinsborough" in Melbourne with only Anglo-Saxon people in it.

Just imagine, those foreigners, stealing our TV acting spots!

Yours,
Deutschy, Equal Opportunity Community Sponsor, Germany 1937

Plunging down the asphalt,
Hot dust breeze screams.
Tearing the road
Destroying it.
Sinking upwards past the valley and
into the hills.

Disappearing without a trace into the backdrop only to find
The car slinks
at night
into the driveway and
close to home.

Dear All,

A phenomenon has surprisingly taken quite some time to come to my attention. Let me give you some examples:

• "I'm happy to be in a relationship"
• "You don't deserve to be a doctor"
• "I'm not very good at being bisexual"
• "Being a surgeon makes you unhappy"

There are all examples of this curious phenomenon of people seemingly treating characteristics and situational things as "stuff" that is owned, and furthermore, stuff that "makes" people happy and that you may or may not be entitled to.

Let me expose this rather insubstantial little lie. Things that are stuff are objects and in grammar, nouns. Characteristics are properties of the aforementioned "stuff" and so, adjectives. Relationships are not a "stuff", but rather a dynamic personal bond between individuals. "Stuff" cannot make people happy. Characteristics and relationships are also not things that you are or are not entitled to having. Emotions, characteristics and relationships exist because we work to achieve them or sometimes merely because we experience and are them. It's not a question of entitlement or ownership- it's a question of existence or non-existence.

You're either a tulip or you are not. You're either happy or you are not. Entitlement isn't really an option or a pre-requisite for "being".

So to all those people who think that they can commodify their marriage, career, kids, relationships, sexual orientation, race, friends by calling these things "stuff" that they "own" and "deserve" - get fucked. You do not even make logical sense.

Yours,
Deutschy, Three Times Deserved Winner of Happiness

Dear All,

After awhile I moved from my broken house, war-bombed to a new one. I had a little money and was in a state to acquire new things and so I was in the market for a new place. They were making some new rooms fashioned in abandoned factories and other buildings and so I thought, why not.

There was the smell of sawdust and fresh paint. Bright, airy light. A warm, sweet breeze.

I had got into a little business with a few people I had met here and there. Exchanging details and just putting myself forward was enough, it seemed. I was once again excited and interested in this city reborn and my joy was shared.

I found myself in a routine but walking about in the sunlight, new suit on my back and attaché in hand I felt nothing but freedom and the simple joy of a quiet, industrious life.

But as life grows more normal, humans find something new to complain about. The weight of others' concerns pressed upon me. And I was bored.

A couple of kittens found their way into my house and I fed them scraps until they were no longer afraid of me. A few birds nested in the exposed roof beams above my lounge room. I acquired some timber and built myself some new furniture and bartered for some old things.

My place became a home, for myself. Alive.

Life was festive and calm. People celebrated with flags waving, music playing. There were parades. Trade links were re-established. Shops were prosperous. There was a hope, a liveliness. Excitement in the air. And I was part of it.

Yours,
Deutschy.

Dear All,

A difficult week, certainly. I got broken into, unawares and without "inn sewer ants". Thus I am $3500 down on my capital gains for the year.

However, I am in myself feeling much better and in rather chirpy spirits. My dreams go to new and exciting places rather than in circles. I feel satisfied.

I just need some more work and to do some more after hours things rather than sleeping and dreaming my nice dreams.

I will be doing a neurovascular project on clipping and coiling cerebral aneurysms. Fun times. Need to finish my case report too, hopefully tomorrow I will bust out another draft. With luck I will be doing either a urology or vascular project later in the year, as well as a ... neuro-endoscopy weekend course? I believe it is on using devices to remove anterior fossa tumours transnasally. Cool.

We had an earthquake of magnitude 4.7 yesterday. It was not particularly strong, but it was quite interesting. Hopefully no bigger ones to come. I did not even know that Melbourne has earthquakes but there you go.

Life is interesting and the battle is on. I have my left arm and my shield back. Good timing I say. When I am dreaming, when I dive into the sea, my heads-up display comes on and I have air to breathe. I see in infrared until I am close to the undersea platform where the navy has a base...

Yours,
Deutschy, Surreal.

I grew up, grew some balls. Learnt to be an asshole and how to smoke. Started wearing expensive pants and watches. Carried a business card. Spoke professionally. Ate the right things at the right places. Got fat. Had sex. Got an STD then got rid of it. Met a girl and borrowed some money and never paid it back. Learnt how to swear in French, in French only. Blew my nose and wiped my bum with raw silk.

And one day, I bought a first class ticket to Amsterdam.

You don't know this but in Amsterdam, people eat ginger cake as if it was bread and cheese as if it's butter.

I was feeling cashed up. That's why I did it.

I learnt to lie and how to walk at the same time.

I was feeling cashed up. That's why I did it.

I found a family of swallows and donated them to a passer-by. I blew a balloon and then popped it, immediately. Because I could. I got in my new care and drove down the highway that circles the town until the night turned grey and the wind turned into a sandstorm and I died and was reborn.

I felt cashed up.

And I, I felt the voices of the ghosts of the past slide past the windows as I slid down, down in my car, down the road, into the tunnel that burrowed into the earth.

The words, they said, they said- it was you.

It was you all along.

I slid, deeper and deeper
until
there
was
nothing
But You.

Dear All,

This:



is to be "checked out" as it were.

Yours,
Deutschy

Dear All,

It was eerily quiet as I headed back home.

Yours, Deutschy

@calamari this is kind of cool! hey btw :)

Fuck I have no idea what is with my blips today.

Can't touch this...

Dear All,

As I knew we would, we outgrew our small corner of the destroyed city and left our house. The house we had constructed out of the wreckage of a burnt ruin. The small life, the world, the piece of beauty and warmth. One day we both hugged (the way we always do) and went out for the day. And never returned.

For days I walked in a daze. I could think nothing but of survival in this warzone. I ran from shade to shade avoiding the gunfire rat-a-tatting from cars, windows, buildings. A bomb exploded not far from me one day; walking past afterwards I saw that three children had died in the blast. A severed hand clutched a toy. I shuddered.

I ate where I could, in the dark. Snatched bits of sleep in abandoned doorways. In tattered beds I shared with cats. On mattresses huddled with fellow orphans of the city.

I was far too wild-eyed, disshevelled, shell-shocked to feel alone.

Then the Armistice was signed.

I only heard about peace coming to the City days after it had happened, in dribs and drabs, in snatches. But something had changed almost overnight in the city. You could feel... not a silence, but a warm buzz in the air. An energy.

Peace.

The streets became safe again and people started to walk around, timidly at first. Every now and then you would see a car patrolling in uniformed insignia. There was no more gunfire.

Not long after that I found another corner to sleep in. A house with a spare room. and I slept and slept.

My dreams were of the war. Missiles careening down into my old house. Nations torn apart. Armies of death, with silence in their eyes. The world ending with billions dead. Tactical warfare. And of a hot hot dry wind blowing harsh sand across the desert and into my city. Burying us alive.

I would wake occasionally to take a piss, to eat some of the food at my door, to drink, and then back to my never-ending dream.

Eventually I started to explore the house I was in. It was one of the few mansions left. An old, massive house in disrepair that was once worth millions. Marble floors. An elegant, sweeping staircase. There was even a piano, and a courtyard filled with light. And dust.

I started to play the piano once more. My fingers creaked and stumbled to begin with but I slowly pieced together what I was aiming to say, in those notes. I evolved a long, slow piece of wandering music. And this music filled my dreams, and my dreams slowly took on the meaning of the present; peace, quiet, harmony.

And then I started to walk down the street. I started noticing people once more, saying hello and smiling. I got to know a few of the local people. Their faces had the signs of wear and tear, of horrors experienced. But they were smiling.

A few shoots pushed up from the cracks in the concrete. Devoid of constant destruction, life was coming back, in the form of growing, sturdy plants, to the City. Houses started to become solid and sturdy- actual walls made of mud-brick rather than corrugated iron shacks. People set up stalls and started to sell all manner of things they had created. And even better, people would huddle around and joke and talk.

I even saw some of the people I used to see a lot. And they were putting on weight, joking, smiling. I started to make plans...

At night I sometimes hear a lost, lone wolf howling at the moon. I am sure I have heard him padding past my door, sniffing, then moving on. Every now and then I try and espy him before he leaves, but I never quite catch a glimpse. I dream about putting furniture and books and luxuries in my house now- not of the war. And I dream about this wolf. I wonder what it all means?

Yours,
Deustchy, contemplative

Dear All,

I figure that if you broke up with someone (in the "real" sense) years ago, one is able to now speak of one's relationship without so much trepidation!

There are often turning points in life, when it comes to the way in which one sees things.

Claire was the first girl I kissed, and slept with. There was that "oh my god so this is what kissing is good for oh my god", followed by the "SEX!!!! oh this is kind of icky but feels nice but where is my orgasm?!" and a night of "oh wow maybe this is going to be like a girlfriend thing and I wonder how I will introduce her to my parents" (that did not happen).

Kim, the first girl I actually liked who I kissed- "it feels so good to cuddle and even though it will go nowhere I am so happy" and of course many many dreams about her.

Then Katie the first girl I dated for more than a week- "fuck I am so happy like all the time and this feels exactly as awesome as it should". Of course followed post-breakup by "I have never felt so cold and alone in my life". That was really quite bad.

And thus, Jacqui. The first person who I felt understood by in any meaningful way- and who I understood as well (at the time). Of course this did not translate to the "first girl I loved" until a full four weeks into going out with her. Then there was the moment when she became suddenly incredibly human- and I did care- not about myself for once but about her. Regardless, just after we had decided to break up we actually (finally) told each other how we felt and she also gained the title of the first person who loved me back. When you think of it- kind of a waste in that way. It felt right at the time to break up, even though it was hard, and sad. But regardless the meaning of being loved was that it was a catalyst that forced me to grow up a lot.

The last three years or so is beyond the scope of this post so to speak. Suffice it to say that my "firsts" have no longer been about my love life. It is not "been there and done that" so much as that there have been other big things occupying me- work, life, study. Meaning has shifted and changed. Priorities have been quite different. I have gone from feeling 18 to 40 to 12 to ... whatever.

Feeling and having felt loved, full, understood changed my perspective irrevocably- and in such a way that I did not need a constant reassurance or reminder- and I got on with my life. Along the way I had many adventures. I saved my first life in my final year of medical school and this changed things again. I failed my first subject. I had my first job, my first place to myself. I for a two years had a series of my first unbelievably raw deals in a row. I survived.

And as I said in my last post- I became capable of loving and caring about others in a meaningful way.

The pieces of the puzzle were thrown in the air and fell in unexpected places.

I am playing the trumpet and herding cats not next weekend but the next, at Monash.

Yours,
Deutschy.

Dear All,

Things have been "a-changing". And I feel much better for it.

So, here is the update.

I wrote the first part of my first novel. It is not too bad, though it is a teenage fantasy novel. Which is "oh-kay". I like teenage fantasy novels (as well as "high literature" and other "works of art").

I am working pretty hard. I need to because of my financial strife. Things are getting there though, however it is going to be hard to balance work and life.

My house has 2 bedrooms. It is big, new, very comfortable and has a large garden. It is great! I still have to move my stuff in but that will happen.

I have a kitten. He is very very cute! His name is Pantalaimon (or Pan for short) and he is Siamese. He is skinny, hyperactive, smart, affectionate and has big balls! Thus he is the cat for me.

I play trumpet in the Monash Symphonic Winds- it is awesome! We played at the Bands Festival and did really quite well. First time I have played in a band/orchestra since high school (despite me being a music geek), first time I have played trumpet full stop and first performance I have played in in at least 7 years! It went alright all things considered. I now have a black shirt and a black tie for the future.

I wear a dress or skirt to work 2 days a week and pants shirt and tie 2 days a week leaving 1 day a week for shirt and pants. Yes, I dress "girly" to work. Exciting, eh? I am also openly gay at work. This is great! I feel so much more chillax as a result.

Work thinks I am very good so far. I will be passing my internship with no problems- though obviously there are things that I can work on. I am applying for a surgical year next. So hopefully I will be a urologist. Still have to decide if there is a year off just before I start SET.

There has been a little adjustment here and there with friends things but nothing major. I have just been spending a little more time on making myself happier and more satisfied- and tweaking accordingly.

I have decided to give up drinking (mostly). Still will have the occasional glass of wine with a meal and a couple of drinks on special occasions but no more binge drinking or random large amounts of drinking after work or anything like that. Honestly- I am kind of sick of drinking. It is not that I have anything against it but it is expensive, I do not enjoy it any longer and I usually do silly things when I drink. Plus alcoholics are pretty shoddy. And it is not hard to be one- just drink 2 or 3 drinks every day and you actually are one by definition.

I am quite a bit more confident, assertive and a lot happier.

I also finally like someone new a lot for the first time in ... perhaps 3 years? It may not be reciprocated for all I know. I think it is but we will see. I do not often find people I really like- it happens at most about once a year, if that. But I feel warm, centred, good, alive. I keep thinking that I feel a little like someone has prescribed me 4mg of dexamethasone BD resulting in generalised well-being and increased appetite... but that analogy means that I am equating my romantic life with cancer, so I shall not do that. She is such an awesome girl! I will not say more until I know more- but suffice it to say that even if she does not want anything I am very happy to stay good friends with her.

And I no longer feel guilty about not actively loving the last person I loved. It has been such a long time since I was in love with her, properly. Probably about a year and three quarters. I missed her so much when she stopped talking to me- but there was so much guilt and lost friendship and regret in my feelings at the time that it was difficult to separate how I really felt. I saw not too long ago that she seemed really happy- and all I felt was relief that I no longer felt that I had forced her into permanent unhappiness. I still care about her- as I would a family member- but how can you be in love someone who does not talk to you? The simple answer is that you cannot. And I have not for a long, long time. I dare say that she stopped loving me a long time ago too. I wish we could be friends or at least on civil terms considering that we are in the same profession. Perhaps it will happen, perhaps it will not. It seems pretty stupid and childish that we do not talk. I am sick of it.

Not much else to report. I am hungry and need a life! Well, and a sleep.

Yours,
Deutschy, Lillehammer to Hamburg in 2.5 hours flat!