Blurberry - urban fruit

Jack III - flowering colour

Batman and I recently went to a small town market day. The markets are run twice weekly and they have a distinctly country feel; everyone is 'chilled out' and things move just slowly enough feel relaxing. Soon after showing up, we turned down a particular row of stalls in a relatively small corner of the place. The smells were overpowering. Lavender, Sandalwood, Rosehip and Orange peel. My allergies went to town. Hastily, we continued on; rainbow and tie-dye hallucinations flicked past. I caught sight of some signs "Have your palm read", "Mystic Medusa heals" , "Essential oils for pure relaxation", "Pure oils for essential relaxation", "Keep colds at bay". And the scariest of all;

There was practically one ailment for each letter of the alphabet. I thought to myself "Who pays money for this $hit". The answer to this question is complex, because essentially everyone does. In fact, when it comes to Complementary Medicine, I've sold plenty and dispensed a bunch on prescription too.

Unfortunately, a large amount of Complementary Medicine is nonsense. Some of it is kosher. Big Pharma's corporate involvement has really validated alot of claims, especially as far as consumers are concerned. Obviously, the corporates on-board with all this too; almost everyone has heard of vitamin ranges Blackmores, Nature's Own and Swisse. I'm sure they're extremely profitable enterprises. There's big advertising too; think TV, magazines, radio, the lot. It's big business. It might even be mainstream.

Take Vitamins. Loosely speaking, Vitamins and essential minerals are an important part of your diet. If you don't get the right about in your diet, you need to get them somewhere. If you can't absorb a certain Vitamin, then you need to get it into your system another way. There are studies and Cochrane Reviews. The pathology is well understood. This is one end of a broad spectrum. That's why the government fortifies your bread with Folate. It's not a conspiracy - it's public health! Next time you're full of doubt, take some time to read about Wernicke-Korsakoff disease or B-12 deficiency. I'm not saying that Vitamins are the only answer. Or even the main answer. I'm saying that Vitamins have a place in prevention and treatment in appropriate patients.

At the markets, I didn't see treatments that had been subjected to a Cochrane Review. Instead, I witnessed (and smelled) Healing Potions of the worst kind. This is the other end of the spectrum. Remedies that I could make in my back yard, even if I hadn't been to pharmacy school. I wouldn't need to purchase any ingredients; I'd just tear up tiny pieces of newspaper, stir them into a gallon drum of water and sell them as a cure for writers cramp. I would call it;

This is the level of science behind the nonsense peddled at the markets. And, in all seriousness, it's the same science as most of the stuff sold in supermarkets and 'over the counter' in pharmacies. If it really helps with disease, it'll have evidence. Find some. What I'm getting at here is that if your only source for the health benefits of a product is the internet, a neighbour, your mum or your uncle's dog, then for your own sake, ask someone with some balanced, certified knowledge. Remember that complementary medicines can interact with your existing medication, and even stop them from working. That's not a health benefit; that's harmful.

As you can see from the earlier quote, I took particular objection to the advertising methods on show at the markets. For me, this is one of the biggest problems in the whole debate. Only two countries in the world have Conventional Prescription Medicines legally advertised to the general population; New Zealand and the USA. In New Zealand, the difference between Prescription and Complementary medicine is clear; it is illegal for medicines to make unproven therapeutic claims. Prescription medication must only be advertised for approved illnesses. That's why you can't use antibiotics for hypertension. Thus, no evidence means no therapeutic claims. Complementary medicine can only be sold under the proprietary name, such as "St. John's Wort", and only suggestions as to the medicine's uses are permitted. By comparison, here in Australia, John Doe picks up a bottle of, say, Blackmore's Proseren (containing Saw Palmetto), that claims it "has been shown to relieve the symptoms of medically diagnosed benign prostatic hypertrophy". The line is blurred. So blurred, in fact, that John Doe may even be believe the quote above, irrespective of any evidence whatsoever.

Recently on the ABC's Gruen Transfer, a panel show about television advertising, one of the guest panelists commented along the idea that in the advertising industry, you can choose one of two paths. Either the consumer essentially uneducated and you're trying to suck them in, or the consumer is educated and you're convincing them to make an educated choice. The panelist nobly chose the latter. I say that for most it's the former. Especially in health. Considering the broad base of knowledge required and the speed at which new knowledge is attained, truly educated consumers are few and far between. In case you're wondering, I'm certain that the lady selling the Sandalwood Healing Potions is neither an informed consumer, nor an informed seller. Maybe she takes Blackmore's Proseren.

As we know, people take complementary medicines to feel better. The placebo effect is a wonderful thing. It has well documented health benefits and, by gum, it made a big difference to some chronic complaints in the time before conventional medicine. Today, it's much the same. Multivitamins for wellness technically live up to their therapeutic claims. They might actually make you feel better for taking them. But they won't help with your cancer, myocardial infarct or diabetes.

My true opinion on all this was deveopled about five years ago, after a conversation with a medical student. We came to a shared conclusion;


Treatment of many conditions need a wholistic approach. It's called the Biopsychosocial model of Medicine, of which I'm a firm advocate. Adjuvant therapy that doesn't interact may be worth discussing with your doctor or pharmacist. There are always options. Get the opinion of a number of health professionals, and give credit where credit is due. Be wary of anecdotal 'benefits'. Don't unwittingly throw away your money. Don't just listen to a naturopath. Don't just listen to a doctor.

I didn't buy any Healing Potions at the Markets. I bought some Old English Liquorice. Batman bought some sandals. We came home feeling very relaxed. That country market atmosphere was so relaxing you could almost bottle it. Almost.

Batman's canine sidekick, Robin, is pretty special. She had some Atopic Issues of her own when she was young, and has a few sensory deficits as a result. Batman sometimes gets worried about her unique dog.

On Tuesday, I noticed a story pop up on my feed about dogs having the potential for empathy. Far simpler than having Rover snuggle up when you're feeling a wee bit down. Instead, the correlation is yawning. Interested, I tracked back to the paper it referenced (which is actually yet to be published), here.

Keen to try this idea out, Batman and I sat next to Robin and yawned profusely. Within twenty seconds Robin yawned back. I'm still sitting here yawning. Batman is dancing around the house, singing.

Robin has curled up and gone to sleep with her rope.

It's Tuesday morning and Wonderwoman and I have been following the Surgeon around like terriers for days. We knew that Wednesday is surgery day; all day. All we have to find out is which OR and when to meet him. But, for him to tell us, we must be ever-present, bad smells.

The rest of the crew has already seen (and scrubbed in) on a whole day of surgery the previous week. I am keen to catch up. So keen.

We are to attend a lecture at the University. In Vietnamese. The Surgeon is a senior lecturer, and he gives us a tour of the facilities before the lecture. After, we will taxi back to the hospital and head home (or to the bar, whatever). It's 11am.

During the tour of the grounds progresses, the Surgeon quietly says to me; "You will come to OR tonight? I am on call at 7. You will help." I nod enthusiastically.

At 6.45pm, I walk my friends to the Irish Pub, then head on to the Hospital. I can hear music on the PA in the street. The Ha Noi nightlife is pumping. Motorcycles are everywhere. Cellphones are ringing nonstop. The smell of dinner is thick in the air. I rock up to the surgical building. It's a good 300m from the ED; inside it's very, very quiet.

I change into scrubs. I tie the thick cotton surgical boots over my thongs. I put on my mask I've just bought for 12000 dong at the corner Pharmacy. As usual, all my valuables are around my neck , underneath. I tentatively walk to the OR door, and the young nurse just inside the door smiles with her eyes and offers me a seat; there is no scrubbing in or out for observers.

I quietly watch, along with half a dozen other Medical Students. All of them nod to me, then elbow past to see. At the end of each operation, the students move quickly to another theater.

I step just outside and wait for the Surgeon's next surgery to begin. He walks off somewhere. The nurse offer me some Pho. It's amazing; the tastiest I've had. We sit on the floor and they practice their english. They're quite good. It's 9pm.

A mouse runs across the corridor, and all the nurses shriek. I jump up. They shriek more at my reaction. They ask if I need new underwear. I tell them that I am surprised my pet followed me to the hospital. They laugh. They pour me more Pho.

Another surgeon arrives. He is big and burly, and the first person I've met here who's taller than me. "Palez vous Francais?", he asks. "Non, je suis desolee. English." "Hmph." He calls the anesthetist, and gets him to explain that he will be repairing a broken humerus. Would I like to watch? Yes, please.

The anesthetist apologises for how bad his English is. It's excellent. We talkvas he places a brachial plexus block. When he is finished, he puts his gown under the patients head and walks away. As is usual in Vietnam, the patient is still wide awake.

We talk about many things, including poverty, capitalism, wages, neuromuscular-junction blocking drugs, families. He tells me where to find good surgeries during the day. We talk quietly as the surgery begins. Five minutes in, the theater is full of students again. Each one inspects the radiograph - a clean break.

We all watch the orthopedic work; the surgeon puts in two plates, and screws them tight. I watch as the nurse squirts water at the smoking drill-tip. I am thankful that I wear glasses when the blood splatters on the surgeons face mask. No one else has glasses on.

When the fracture has been reduced and fixated, the vascular team set about repairing the vessels. This is too slow and boring for the students. They head off. The burly surgeon stays to watch. He says to me, "You are here from start to finish. Very dedicated." I nod. We watch. It's 10:30pm.

Ten minutes later, the burly surgeon turns to leave. When he reaches the door, the young nurse says something to him. He turns to me and asks "I have elbow now. A young man. Scrub in." I smile and nod. "Thank you."

It's nearly midnight. The gown is hot. Gloves that I wear usually without issue have become dark with sweat. My cap is wet. My forehead glistens. It's at least 30 degrees in the OR. A nurse giggles and wipes my brow without being asked to. The surgery has been going for ten minutes.

"How did the patient do this?" I ask.
"Moto."

I am standing at the patients head, near the monitor. The kid is sixteen. I look into his eyes. He looks back and smiles. The surgeon repositions the surgical site. "Hold it here. One hand only." He gives me the forearm. I hold it turned to the kid's chest, out of the way. I can feel his pulse.

The burly surgeon gives me the suction. "You know how to use?" Yes. (I think so). The nurse fits the wire pins into the drill bit. Bzzzzzzzzz. Water. "Suction!" Suction. Bzzzzzzzz. Water. Suction. Bzzzzzzzz. Water. Suction. Three pins in.

"Now we close. Can you stitch?"
"No"
"Okay, you cut. 10 millimeters."

He begins to suture. "Cutty." I cut. One, two, three, "Too short!", four, five "Good!", six, seven, eight "Too long!", nine... fourteen stitches. There is nodding all around. The surgeon steps away.

"We are finished." It's well past one in the morning. "You have stayed long. Go home now. Celebrate." The nurses are dressing the wound. The medical students wait at the OR door to plaster.

I walk back through the streets, sweaty and exhausted. The night has eaten the city. It is silent. My senses scream at me. The sound of the drill. The smell of burning bone. The taste of my sweat. The feel of the cold steel scissors.

And the patient's eyes. His smiling eyes.

"What aspect of Scleroderma causes the most mortality in an elderly population?"

"I was watching A Current Affair last night and the showed this kid with some sort of CNS tumour. It was quite moving. Anyway, I wanted to ask, firstly, did you see the show, and secondly, your thoughts on leukemia in the elderly."

Tonight Batman and I went to watch The Dark Knight (it was her second time) and I was utterly enthralled. Heath Ledger is captivating, to say the least.

The Batman series, to me, presents an interesting picture of psychotic illness. Obviously, both The Joker and Two-Face are off their collective rockers - that's kind of the point - but Batman, too, ain't all under control. I s'pose that's one of the recurrent themes in several super-hero films/comics/ and the like. It's all about staying in control of what you've got.

Inherently, as Peter Parker points out, "with great power comes great responsibility".

I'd suggest that The Dark Knight and his other super- heroes and villains are just a wee bit closer to the edge than most of us. They're struggling (+/- failing) to repress anger or fear or other primeval emotion. They must control it, sometimes through an 'outlet'.

In the context of everyday life; the whole 'keeping it under control' is what some people keep as gospel. The fear 'losing control' might even be what drives some Med students. The need to stay on top of it all, the fear of failing. Or killing someone. Everyone need to feel in control of something.

That's the absurdity of the Joker. He controls everything and nothing and doesn't care.

With or without opioids, benzos, papparazi, sedating antihistamines and the lip-smacking extra-pyramidal side effects; I'm strongly willing to consider that 'method acting' for this role was the end of Ledger. The Joker was one psychotic man.

Squares into Circles

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Circles into Squares