Frogland Trip Day 1: Arrival (26 Sep 2010)

Since M nicknames me Frosch, my homeland Taiwan is naturally a frogland. Haha, sounds like a real habitat.

During an online chatting back in May, I invited M to come for a visit. Because winter semester in Germany starts in mid-October, M decided to visit in late September, along with his friend, FD. On the other hand, I was doing a health checkup rotation in September and an ICU rotation in October, thereby having a more flexible working schedule. Sounds perfect, huh? Actually, I had made some efforts to make all the pieces fit together. It is not an easy task I'd say.

As a side note, I had to sit in the official license exam for internist on 25 September, the day right before their arrival. I had spent most of my downtime studying over the past few months and became so wound up. Planning and organizing the trip has become an escape to my tension during those days, although making the plan was sorta cumbersome. But the cumbersomeness per se is also where the pleasure lies.

When I looked for accommodations, I found some short-term or day-rental apartments (and they are in increasing numbers in Taipei, but I've learned that such accommodations are forbidden in NYC now). I picked up the one located off the center but apparently comfy and with a nice panorama of the river.

The place is in the proximity of the red line Chuwei MRT station, so the downtown area is readily accessible in less than 30 minutes. (It's a shame that the webpage is written solely in Chinese; for those who don't read Chinese, you may inquire the landlady for details via emails.)

A marvelous shot out of the window by FD.

It was super sunny on 26 September. I got up late in the morning, trying to recover from the exhaustion caused by preparing for the exam lately; it felt like running a marathon and finally having the chance to gasp at the finish line. Nevertheless, I felt extraordinarily delighted for what I've accomplished and for what awaited ahead: the frogland trip.

M and FD took the China Eastern Airlines and stopped over at Shanghai. They arrived half past 7 pm after a couple of hours delay. I haven't seen M for months and I never met FD in person, so I was eagerly staring at the exit in the fear of missing them. Well, the worries were apparently unnecessary. M is almost 2 meters tall and FD might be 2 cm shorter; when they came out of the automated door, I recognized them immediately.

We exchanged hugs and I told them about my observation.

"Like the twin towers," FD came up with the term.

"Exactly," I concurred.

Sonnenblume

Sonnenblume, originally uploaded by quasirobot.

Someone gave me this sunflower as a token of our friendship the day I arrived Berlin. I stayed in the city for 4 days.

I booked a night train leaving Berlin for Cologne some time past midnight, so I had to carry this flower with me walking around the city after checking out of the guest house. The café near Siegessäule was closed. I sat at one of the empty table, trying to aim a perfect angle at the statue. I put the flower down and voilà, it suddenly dawned on me that this is a very poetic and nostalgic composition, so I took this picture. And, yeah, it turns out to be one of my favorite pictures during this trip.

Running cart, Mercedes Museum

Running cart, Mercedes Museum, originally uploaded by quasirobot.

This pic was taken in the Mercedes Museum Stuttgart last September. I pressed the shutter accidentally while I was still focusing my lens on the cart. But when I checked the picture afterward, this out of focus one appears more vivid and interesting than the other perfectly focused one. Well, it's apparently a bumpy ride, don't you think so? :-)

Fade away

I felt a bit gloomy today.

One of my patients is a 22-year-old girl who was diagnosed with acute lymphoblastic leukemia 2 weeks previously. Chemotherapy has been given over the past one week. Now her white cells dropped to a dangerous low. She is really vulnerable for the time being. Yet, apart from nausea, anorexia and other discomforts caused by chemo, she started to experience some emotional problems.

She wanna go home and had a quarrel with her mother, who tried to reason with her and stopped her from doing so. I went to see her in the evening ward round myself. She appeared downbeat and repeated her capricious wish of going home today.

I can't blame her too much. She used to be active and healthy and has a rosy future but now she is confined to the hospital ward, struggling with her own dear life. I can't promise her anything, either. Even though her leukemia seems responsive to chemo, she has a long way to go after this: several cycles of chemo, hair loss, loss of appetite, infections in between, stem cell transplantation, graft-versus-host disease or possibly, treatment failure. That's too much for anyone. If I were her, I might be even more fragile, even more unreasonable.

She collapsed in her father's embrace, crying like a baby. Witnessing this made my heart tender. I felt my eyes wet a bit.

Leaving her undisturbed, I walked out of the room without saying another word.

Butterfly orchids

I went to a butterfly orchid garden in the last Sunday afternoon. There was rain earlier that day. Normally I would rather stay at home in such a crummy weather, but since it's my last weekend in Yilan, it's my last chance to pay the garden a visit.

The orchid garden is owned by my patient's son-in-law. I learned this in a chitchat with the patient, who had some lovely potted butterfly orchids in her bedside. I was intended to buy some orchids, so she invited me to drop by the garden right before her discharge.

It took me some time locating the place. For starter, I've only been to Yilan for barely one month and I worked most of the time, so apparently ain't familiar with this area. Besides, I worked on-call in the hospital the previous day and had poor sleep; I felt a bit groggy even though I've got a nap that morning.

The garden is a misnomer I'd say. It looks more like a greenhouse to me. Ha, my facial expression might betray my thoughts before I realized it. Mr Lu, my patient's son-in-law, told me purposefully the orchid garden is not for sightseeing; they're mainly doing business with merchandisers overseas.

Mr Lu is a friendly and generous chap. He allowed me to take photographs to my heart's content and told me about growing orchids and developing new species by hybridizing, which involved a lot of try and error. They experiment on colors, petal textures, blossom timing and a variety of different things. Once they got a successful hybrid (from the aspect of marketing), they are faced with another task: making clones. The funniest and riskiest part of the business lies here because one cannot predict the results perfectly well. Normally the whole process takes 5 to 6 years.

Mr Lu is very proud of Taiwan's pioneering biotechs in the development of new butterfly orchids. Even farmers who haven't received formal educations have the knowhows. Yet, on the other hand, he cannot help but whine about the government's pretentious promise of promoting the agricultural industry. He said a lot of farmers who don't have the proper marketing may sell out their hybrids to merchandisers in a much lower price than it would have been. The patent is apparently given up way too easily.

I came across with a news coverage earlier about the fact that Taiwan relinquishes its crown of butterfly orchids kindom and passes it on to Holland.

"Holland is richer and more industrialized," Mr Lu frowned slightly.

But he told me he's not that pessimistic since the weather is a lot better here. The orchids stop growing when the temperatures drop below 10 degree Celsius, so while Taiwan can grow the flowers almost the whole year, Holland is unable to continue in the autum/winter.

Right before my departure, Mr Lu showed me his newest hybrid. It's a bit bluish and a bit violetish. I inquired how much it costs, but he told me it's not on the market yet.

He gave me another lovely potted orchids as a gift and welcomed me to visit the garden again.

Emotional detachment

You asked me whether I had breakdowns taking care of cancer patients. You said it would seem to be quite depressing and frustrating at times.

Nope, I had not. I haven't been overwhelmed by those negative emotions thus far. Perhaps I was subconsciously resistant to those thoughts or maybe I was too busy working to ponder things over.

Dunno. We're all taught to be empathetic toward those who suffer. Nevertheless, working where tears and death are almost always around the corner, one can not survive without some level of emotional detachment. In health care, if one takes everything personally, sooner or later one may explode.

Still, I'm not iron-hearted. Delivering bad news to patients and/or their family remains daunting to me.

Stan* has cholangiocarcinoma, cancer of the bile ducts, which is notorious for its resistance to chemotherapy. Once the disease progresses, there is virtually nothing in the current medical armamentarium that can help. Stan's cancer has gone beyond control. Time to stop. I told him so, but he, probably too shocked or frightened to absorb the fact, desperately asked for therapeutical trial of the latest chemotherapy/targeted therapy regardless of the effectiveness, the side-effects or the cost. I insisted on 'do no harm' and somehow refused his requests mercilessly. Yet, I actually felt a bit shaken behind the professional facade. I felt as if I'd become one who deprives poor people of their last hope.

A patient collapsed unexpectedly this past weekend. The intern, who took care of this patient, cried the whole morning, blaming herself for not being preemptive enough. Seeing her lose her composure, I feel a great sense of loss. I can't think of the last time I cryed over a dying patient. I feel the emotion no more.

Am I too nonchalant or too business-like? Hopefully not. There aren’t any checklists for us to follow on how to maintain boundaries when faced with the emotional demands of others.

I'm still trying to find balance.


* the name has been modified.

Love is a losing game

For you I was a flame
Love is a losing game
Five story fire as you came
Love is a losing game

One I wish I never played
Oh, what a mess we made
And now the final frame
Love is a losing game

Played out by the band
Love is a losing hand
More than I could stand
Love is a losing hand

Self professed profound
Till the chips were down
Know you’re a gambling man
Love is a losing hand

Though I battle blind
Love is a fate resigned
Memories mar my mind
Love is a fate resigned

Over futile odds
And laughed at by the Gods
And now the final frame
Love is a losing game

Go upstream

尋夢？ 撐一支長篙 向青草更青處漫溯，
滿載一船星輝， 在星輝斑爛裡放歌。

The Chinese poem written one century earlier is my first impression about punting in River Cam. Although the scenario was not exactly the same as what he described gracefully in his poem, I still enjoyed the afternoon breeze and sunshine when I lazily dozed off in the boat.

We went punting a couple of times throughout the 3 weeks in Cambridge. The River Cam was always crowded with tourists, bantering and laughing. It's said that we could enjoy some peace and quiet if we go upstream. So, by the end of the summer school, we decided to escape form the crowds and organized an upstream punting excursion.

It takes a bit strenuous work if you'd like to try punting in the upstream. Yeah, you have to drag the boat offshore and upward along the slope as the picture shows.

Thanks to our inexperience, we've caused a traffic jam when the boat stuck in the middle of the road for a few minutes. Those people who were waiting to cross the road shot nasty looks at us unceremoniously. I thought we'd win some applause as we pushed the boat back to the water successfully and relieved the traffic jam, but there's none. lol

The upstream was apparently more primordial. It felt like the scenario in a B-movie where there's a python lurking around somewhere and we're the would-be victims. lol. Fortunately, nothing surrealistic happened that day.

We spent the whole afternoon there until we were almost running late for the closing dinner of the summer school.

Mr L

Mr L used to be a high-ranking IC engineer in Silicon Valley. I wouldn''t have gotten to know him if he was not inflicted with lung cancer.

He did not smoke and only had minor health problems previously. However, he began to suffer from lower back pain during the summer's peak a couple years ago. Mr L took painkillers and underwent rehab after seeing his family physician. Yet, the pain did not go away. A spine MRI was thus undertaken, right before the Christmas Holidays that year, and reportedly showed multiple metastatic lesions along his vertebrae. He was diagnosed as having adenocarcinoma of the lung and started the latest targeted therapy available.

A miracle did not happen. By the time I saw Mr L, he was undergoing another cycle of palliative radiotherapy for the agonizing metastatic bone pain in both of his shoulders.

Mr L appeared depressed; his wife, Mrs L, on the other hand, was anxious and sometimes a bit demanding. Even though that was understandable, it was cumbersome for myself and nurses, to some degree, to take care of such a patient and his family.

I'm not good at encouraging others, let alone those who are dying chronically. I've tried a couple of times to comfort Mr L. Yet, it sounded awkward and lacked genuineness, especially when the medications I gave him did not work while he was suffering from intractable pain, or instead rendered him nauseated.

In the context of taking care of terminally ill patients such dilemmas are not uncommon. For example, using morphine to ease pain may cause severe, distressing constipation. Palliative paracentesis, if not undertaken judiciously, may jeopardize a patient's renal function. As patients lose their physical capabilities, and must obtain nutrition via a nasogastric tube for example, they sometimes become very depressed and even lose the faith and strength they had to stay alive. Some even become indignant and refuse treatment even when suffering from severe symptoms. As you can imagine this can be quite problematic for us as their care-givers.

Luckily enough, Mr L's pain was relieved and his nausea and constipation were more tolerable after several rounds of morphine titration, along with administration of antiemetics and laxatives. Toward the end of that month, he received another course of chemotherapy with a different regimen.

Sometime later after I rotated to a different ward, I met Mrs L down the corridor. She said that Mr L is going to be discharged home in a few days. Although the effectiveness of the new regimen is yet to know, she told me that Mr L's general well-being is now good and she attributed this to my meticulous care the previous month.

"That's what we are supposed to do," I insisted but could not help smiling.

Hualien

You were run off your feet working. Whenever you stopped to catch your breath and looked out of the window, the weather appeared lovely and charming. You wondered when to go outdoors to embrace the sunshine yourself. Finally, you had a weekend off and determined to leave the hustle and bustle of the city behind. Unfortunately, your weekend off was accompanied by the cold front.

The first weekend of November, when we visited Hualien, was like that. Cold. Damp. Annoying raindrops all day long.

No, I'm not a whiny person... Well, at least I wouldn't have been.

Actually, the weather kinda reminds me of the UK when I was there this summer. So nostalgic and so poetic. It's, however, not quite right for those of us who are overworked and need some sunshine to sweep the gloominess away.

It's not my first time visiting Hualien, but previous memories have long since blurred. Hualien has gotten more and more touristy over the years. The infrastructure appears better off, apparently for the sake of tourism. Fancy souvenir and omeyage [local produces] shops are everywhere now and so welcoming.

Hualien, located on the eastern edge of Taiwan, escaped tourism for many years because Taiwan’s central mountain range posed a significant hindrance to explorers stopping them from rushing in. Hualien’s isolation became its advantage sparing it from over-exploitation. Yes, over-exploitation. Just look at what we have in the western part of Taiwan: Pollution. Pollution. Pollution. I'm afraid the planned build-up of new highways may accelerate the corruption of Hualien's natural beauty.

I'm not a hardcore environmentalist, but I don't trust all those politicians who merely want to feather up their own nests. What if poor construction causes irreversible damage to the environment? It seems like a lose-lose situation to me.

Fortunately, as long as disagreements continue to halt actual construction, the nightmare will at least be delayed.

One of my friends seemed to be really attached to Hualien. Along the journey, he kept daydreaming about moving there, working in the Mennonite Christian Hospital and living in one of Hualien’s villas with their magnificent facades. I was kinda sucked into this dream weaving process, well, at least for a little while.

Currently in my late twanties, I spend most of my life in the city. Although I enjoy the countryside's peace and quiet, I can't live without convenient transportation and vivid commercial activities for too long. Taipei is noisy, often chaotic, a place we like to complain about. Yet, the noise and chaos are the driving forces of the city and, strangely enough, the driving force of my life as well.

Maybe all the downsides of living in a city may heighten our pleasure in escaping it for holidays.

Hualien is certainly a great distraction for the weekends, even if there's no sunshine. Crummy weather can’t keep you from avariciously breathing in fresh air while wandering about the Taroko Gorge and acquiring inner peace sitting by the Pacific Ocean.

Get started

I'm thinking about starting my own blog for a while, but cannot really make up my mind when and how to do this. Working long hours is a perfect excuse to stop me from doing so. Still, it's an excuse. Perhaps it's more out of an inner fear of my poverty of thought and lack of insight to life. I wonder how other bloggers have such an abundance of experiences to share. I'm not a good storyteller after all.

Why now? I dunno. I worked on-call yesterday. Although exhausted now, I feel uninhibited and propelled to write something down. I become a bit philosophical when I'm stressed out. LOL.

Also, I kept my record of life on a bulletin board system maintained by a friend of mine over the past 8 years or so. The system crashed recently for some elusive reason and all the words and memories disappeared. It's a huge blow to me.

I guess it's time to move on and establishing a blog seems a good start.