Have been in Thailand! Much to see, very hot, very humid, air is mainly fumes and water. Delicious. Also delicious is Thai food (AMAZING, and like a pound to eat out) and doxycycline (anti-malarial, not actually delicious). Took sleeper train to Chiang Mai from Bangkok, slowest and rockiest train ever but functional and kind of enjoyable because of it’s crapness. Chiang Mai is awesome and chilled but slightly overtouristed. Large night market is amazing, great atmosphere, but mostly tat rather than actual useful things. Temples have more tourists than monks, have lost their character and their soul. Somewhat tragic, actually. Still, more temples in other places, and we shall visit them instead. Going on a off-the-tourist-trail rainforest trek for tree days (LOL see what I did there)* in a couple of days time, learning how to live off the forest and make traps and fires and hunt stuff and not get (badly) poisoned, so it should be pretty amazing. At the time it will doubtless be a humid hell on earth with a side of mosquitoes and having to eat tarantulas (not actually joking) but on retrospect it will have been awe-inspiring, had nothing bad about it, and why aren’t you guys booking tickets already?! Three nights, one in a hut thing in the jungle somewhere and one with a village which has limited contact with the outside world, so no facilities or tech or anything, just subsistence. Mixed feelings of thrilled anticipation at general fantasticosity and dread for being boiled alive in own sweat/blood (delete as appropriate).

Otherwise life quiet on the eastern front, Thai people generous but difficult to get rid of sometimes (tuk tuk? tuk tuk? tuk tuk? ARGH), on the whole very positive experience! Rainy season living up to it’s name approximately half the time, fortunate as cannot burn with rain and doxycycline makes you burn lobster-red in like 5 minutes. Also lucky as suncream decidedly not waterproof! This is no good because it means that sweat washes it all away and on to your clothes leaving white marks everywhere (NB wear more white clothes). Not to mention that you are no longer wearing sunscreen. Never mind. Now off to go watch Thai boxing match in town, should be an experience, shall see.

Trust you are all well, dear readers, and that life is treating you swimmingly wherever you may be. Watched F1 race in bar yesterday, actually quite enjoyed it but did only watch the last half. Sure someone might be pleased to know that. Also safety car = a beautiful car.

Signing off for the day,

Me.

*definitely not originally a typo.

So yes. The last few days in NZ passed without too much to comment upon aside from the actual drive up to Franz Josef (a tiny little town with two streets, one supermarket, three bars and about ten hostels) and being on the glacier. The station wagon was an ancient Subaru (sounds good I know) Legacy estate car, which was built like a tank, insanely comfy, and handled like a brick on a concrete raft. It must have been underpowered when it was made, the clutch bit about a centimetre from the top of the pedal movement, and the engine had no pull at all below 3000rpm. Like none. Still, it was pretty spacious and cheap and as such, pretty damn good. We drove up from Queenstown over a mountain pass to the west coast, and then on up north until we hit Franz Josef. It was around 5 hours total but we managed to string it out with lunch (by a 90ft waterfall in the sunshine in the mountains) and a couple of stops along the way. One of these was a long, deserted beach, which went on for miles. All along it were pieces of driftwood wedged into the rocks at the high tide mark, as far as the eye could see. It had a strange, almost morbid surreality to it – the air of a memorial is perhaps the best descriptor. It was quite striking and it was quiet in the car when we left.

Then there was the glacier walking. This could’ve been an amazing day but was reduced to merely average by the determination of the guide to cut steps in the ice all over the place, where the crampons we were wearing would’ve coped just perfectly with it. This in itself wouldn’t have been an issue except that it took up a good hour and a half or so of our 5 hours on the ice. Frustrating. On the plus side, we got to walk in the bottoms of some crevasses, squeezing through gaps which sometimes were pretty marginal (breathe out and PUSH type gaps rather than oh-my-bag-doesn’t-quite-fit gaps). The ice down there is the usual stunning blue and I very much enjoyed that part of the trek. I also found myself feeling strangely at home; whether by virtue of Everest or something else I don’t know but when I see a towering river of ice in the mountains I feel rather comforted. Bizarre.

Then we left, drove to Christchurch, saw Salt (average Hollywood fare) and Harry Brown (very gritty, very British, worth a look), and flew the nest after one night.

And now I am tired. The rest can come later.

It’s not all adrenaline rush here either, although admittedly there is a sizeable chunk of the population here who are both tourists and skiers, so the place is notably busier in the evenings as an aprés ski night out. This is a shame as it means that the proportion of what I can only describe as ‘twats’ is greatly increased. Coincidentally, the proportion of Americans is also much higher. There are genuine out-of-Hollywood-teen-movie jocks here. I thought they were a joke. Never mind.

There are two things that are important to know about his place once you discount the skiing and the adrenaline sports: frisbee golf, and Fergburger. The former is a little like crazy golf, and if you’ve got a frisbee it’s free. There are 18 ‘holes’: either posts you need to hit or baskets you need to land your frisbee in. It’s all in the park, which needless to say has gorgeous views of the scenery, and because everyone is skiing it’s kind of empty.

Fergburger is less scenic and elegant but is worth a mention simply because they the burgers they sell there are phenomenal. Like, in my whole life I have never had a burger that good, phenomenal. And at ten dollars for your evening meal it’s damn great value as well. And did I mention that it tastes phenomenal?

We’re driving out to Franz Josef, a tiny town on the west coast, on Monday. There’s a glacier trip there which will be pretty cool, and then we continue our drive up to Christchurch the next day. Thursday we fly out to Thailand. We hired a random car -there was a deal on relocating a random vehicle back to Christchurch. The random car thing has turned out to be a station wagon – I haven’t seen it yet but it sounds massive. On the plus side it’ll be good in snow and there is plenty of that about here.

I’m rambling. Will write more if and when something happens.

*apart, of course, from the actual buildings. These continue to be the strangely prefab-looking single-storey buildings which are ubiquitous here. In a word, they look crap.

It was defintely the coolest thing I’d ever done but then today I jumped out of a plane from 12,000ft, which was equally phenomenal (and probably more so). Nothing quite like falling through the sky over incredible snowy mountains, literally over a rainbow, with raindrops hitting your face at 200kph.* It’s been a near-perfect weekend, is all I can say really. And I am sorry for this basically being a ‘oooh, look at meeeee’ post but what the hell, you only do these things very very occasionally so I’ll shelve my guilt.

Anyway, I’m at an internet cafe in Queenstown over the road from the hostel at present and so I think I’m going to have to call it quits now. My internet access is going to be a lot patchier over the next 5 weeks so updates will become few and far between. And when they happen they may come all at once.

Take it easy bros, ay.

*Actually that kind of stings your face but the overall amazingness makes up for it.

After a minute or so I realised what that was. The patient wasn’t breathing. Their chest just kind of shook slightly, an uncoordinated fasciculation, while the patient stared upwards with sightless eyes – open, but totally unaware; consciousness-stealing propofol running through his veins. It’s strange because I’ve always kind of considered that heartbeat and pulse would be the cornerstone of my instincts regarding death but this is evidently not the case. Without breath, my subconscious was screaming death, but the ECMO machine was beyond that. Somehow the ventilator, the dialysis machine, all the organ support systems which maintain life in the presence of an absolute system failure have never evoked the feeling of abhorrence which this construct did.

Of course, I got used to it. Medicine requires it, and I’ve spoke to people who’ve had ECMO save their lives before. It is a powerful tool in the intensivist’s box of tricks, and there is occasionally simply no other choice. This patients lungs were filled with blood (swine flu is not always the mild disease of 99%of cases) and without the support of ECMO he would long ago have been dead, choked on the very fluid he was trying to oxygenate.* Thinking about it now, I visualise not this dark, bloody technology that my instinct would have me see but instead a powerful weapon to resort to when all else has failed. It has its issues – the ECMO machine has the capability to maintain life far beyond the point it should have ended, and it is a scarce resource (the last time I checked there were 8 ECMO beds in the UK). Ethics galore.

I’m glad I saw this. I’m sure one day I’ll be able to explain just why it was so potent an experience.

*they tried to bronchoscope him but they couldn’t suction fast enough to counteract the blood flooding his lungs. When they stopped trying it filled right up to the top of his endotrachel tube. Doctors looked at eachother, shrugged and just said “well, we’ll try again tomorrow” which was impressively blasé.

I listened silently as the doctor explained what the likely course of the disease would be. A steady increase in weakness. A progressive decline in mental agility and, eventually, consciousness. That it would not be painful, and that it was a matter of months.

Through it all, this woman sat serenely, facing her ‘imminent end’ as she put it with this incredible dignity. I can only hope that if I am in a similar situation one day that I will be able to manage half the grace that she showed in the face of death. The doctor offered to call her daughters to inform them of her decision. ‘That would be lovely, thank you,’ and there it is. I supposed after 80-odd years you can have lived the life, done what you wanted, and be ready for it to be over.

I looked out of the window and I saw a greying cloudy day, but I can ever-so-easily imagine that, if your days are numbered, it could be one of the most precious things you had. I don’t yet understand how I’d be able to face losing that.

Funny thing, this elective. On the weekends it’s a holiday and during the week it’s something quite separate.

And they were. And they called out to their group, and their singer, and like a flock they surrounded us, and together they serenaded us with a Maori song. And then they got on the bus, and they drove away.

I bloody love this country.

*a day where you get on a bus with a bunch of people and are transported about to various places to do stuff, but you have no idea in advance what these things might be.

And actually, it was amazing. Three hour drive, which was just stunning. Hostel with a geothermal swimming pool and a dorm, which while about 300 degrees** were a lot of fun. And then caving and luging and a massive swing thing and all sorts of stuff that broken arms probably aren’t supposed to be involved in. ‘t was awesome.

Luging: not actual, face-inches-from-the-floor luging, but some kind of strange mini go-kart things which you ride down a track which winds down a hill, then chairlift back up to the top. Sounds pretty tame but they are low to the ground, skid happily around corners, and the more advanced trails are damn quick and come complete with chicanes, banked corners, and steep straight sections.

Caving: the caves at Waitomo are filled with freezing water and freezing air in equal measure. We were (wet)suited and booted, and floated through the caves on inflatable tubes, pausing occasionally to jump off waterfalls or squeeze through rocky clefts. You can’t quite convey the atmosphere down there – the darkness is absolute, and the thunder of unseen water is constant and somehow both threatening and intriguing. Underground the caverns are timeless, grand and mysterious even in the well-travelled, guided sections we explored.
On top of all that were the glow-worms. At points we turned off our lamps and plunged into absolute nothingness, only to glance upwards at the constellations of them above. Stunning.

Geothermal park: pretty tame by comparison, and most definitely not worth the $30 entry fee. Go to Iceland, as it’s infinitely more awesome. A steaming coloured pool doesn’t do it for me anymore unless it regularly explodes or something.

Summary: this sort of weekend is why I came travelling. I’d write more but it’s time to hit the wards again…

*operative word: ‘theory’. Broken arm much.
**botha the room and the pool, actually.

Right, we’re coming in to the town location now, so I’ll write more later.

Later: now flying back, with a child and father on board. The kid isn’t too ill at present – it’s more a worry about deterioration later today that prompted calling in the chopper. We’re landing directly on top of the hospital, with medical priority through Auckland airspace, as facilities aboard the helicopter are understandably limited and there isn’t a lot of free movement if anything should go wrong. Weather is rough as well; can’t see anything and there is significant turbulence so landing might be interesting. On the plus side, PICU is about 100m from the helipad so won’t be much delay between landing and being on the unit. ETA 15 minutes.

Later again: day done. Admitted the little boy to HDU (high dependency unit – a step down from true ICU in the quantity of nursing and intensity of treatment, but beds are inside the overall PICU so transfer is as easy as moving staff if necessary) for the night, having spent 6 hours completing the transfer door-to-door. It’s been a pretty awesome day, no less, and totally not what I expected to be doing! Learned a little along the way, but mainly it was just damn awesome.

And that’s that. Pictures to follow.

Literally. Directly. With my own eyes.

Holyshit.