July, 2017 – Trip to Bangkok + Koh Tao;

今天是返回香港的第二天。補了相當長時間的睡眠,但精神狀況似乎沒有比在濤島時候好。亦似乎漸漸的又回到日常之中,這是一種相當可恨的感覺。我實在不願意再輕易的又回到這次旅行之前的身心狀態:疲憊、無力、dissociated、混亂、irritable。我相信最好的方法是回顧一下這次旅行的種種,或許就能夠從中得到一些啟示,讓我好好的保守一下心靈。

假日在港的日常:睡到十點十一點鐘,然後在一直賴床,玩手機,到餓到迫不得已,就稍作梳洗,踢住拖,到新都城三期去吃一碗雞肉墨丸大麻辣加細白肉,兩杯水。打一個嗝,再到二期走一個圈,看看中華書局有沒有甚麼好書可以看(多數都係白走一趟),然後就昏昏沉沉的回到家裡去,看書看動畫片子打個機,累了就午睡一下。醒過來後又玩下手機,也差不多是晚飯時候了。


準備

這次旅行其實來得有點草率,基本上是pop-up event。直到得悉自己要在深切治療部再多留一個月到七月尾,我才把心一橫去劃低這個annual leave,那時候是五、六月的事。然後一直就去搜羅廉價機票,ie 走不出港航的手掌心。本來想去日本,因為太過掛念日本拉面了。於是看了好幾次日本城市的機票,發現大阪的機票非常便宜,連稅只賣大概一千四(沒有記錯的話),都已經開始籌劃行程之類,不斷的看其他人的遊記之類,卻發現問題到了︰我完全搞不懂那個地方的交通住宿與天南地北景點玩法之類,亦沒有真正想做的事。另一個原因是一月份時候到過沖繩潛水,一直就念茲在茲,但大阪沒有潛水的地方啊=v=!!! 於是就不斷拖杳著,直到再回顧機票的時候,都已經跳到二千了,頓時心頭一怒,放棄了這個行程點。

原來一個人去旅行啊,最首要的是知道自己到底因為甚麼原因要出走,還有就是到達目的地之後,自己打從心底裡最想做的事。其實人生啊之類,甚麼規劃,大概也是在說這種事情吧,要定下目標,然後就要穿越路上的障礙並克服當中的困難,往標桿柱直跑。人啊,大概最困苦的是失去了目標,然後一直在混沌裡蹉跎。

這也是為甚麼,不能夠把工作視作人生的全部,更何況,它已經佔據了你生活裡最大部份的時間了。

為甚麼會選上曼谷,以及之後找到了濤島這個地方,也很明顯喇,就是機票便宜,預計消費水平相對較低,還有濤島是世界最大的潛水員生產工廠,簡單而言:平、靚、正。當然,as a rather minor reason, she has been to there too recently, with her sister, and had some beautiful and nice photos back; 卻又同樣很明顯,在不同時空裡站在同一個地方,我與她的生活模式與選擇是不同的極端。我的旅行,若然是一個人的話,走的都是窮遊路線,甚少計劃以外的享樂成份,住宿飲食都是低端路線(雖然經濟方面再不成任何負擔)。

今次是第二次一個人到外地去旅遊,所以在計劃行程的過程裡還是有很多不成熟的地方,而且花費了許多時間在意義不大的東西上,意思是:看過了讀過了許多資料,卻都不能夠記到腦海裡去。

大概作為回顧的話,下次可以試試這樣:

 

  • 首先定明旅行的長度,是否希望留下一些時間空間去梳理一下自己的身心情況,比方說預留假期的第一天以及最後一天,是自由時間,在港休息。
  • 定下旅行的目的,今次是潛水,那麼下一次可以是賞櫻,或者純粹文化參觀,若然是與朋友同行的話,又有沒有甚麼共同/ 非共同的目的呢?
  • 然後選擇目的地
  • 機票時間問題,以這次旅行與上次到沖繩的經驗而言,還有再上一次與周氏到台灣,凌晨機可以是一個option,然而之後的接駁亦將是一個要處理的問題。以今次的12mn-2a,實在有點傻瓜,因為沒有考慮到抵埗後入境、交通等問題。返港安排亦然,今次選了八半機,結果要趕早班地鐵,還要趕出境,實在沒有必要。這些錢省不得。所以亦換句話說,first day 同last day 的安排要仔細一點,要把機票以外的交通接駁,花費等搞清楚。弄一個excel spreadsheet 試試看?
  • agoda 的推介真不錯,旅客的評語亦很到位。下次亦應該試用一下網絡版呢。
  • 再強調一次交通的考慮!當真要讀熟當地的鐵路、巴士等情況。
  • 計劃時候還是把最重要的地點先掌握好,再想住宿問題吧。agoda 真的很方便。

大概夠了吧,哈哈。


 

Day 1-2 in Koh tao

Lethal mistakes 

  • Drank alcohol (vodka and a large bottle of beer) last night
  • Had an oily and rather big breakfast (4 slices of pancakes)
  • 1 cup of hot americano leads to gastroparesis
  • Travel pack – got piriton and prednisolone, but how come i did not put any maxolon, stemetil, loperamide etc, in.
  • Stressed a bit too much in last 2 nights.

Difficulty to achieve neutral buoyancy, my ligaments are too tight and often when i swim, and esp when i adjust the mask, i lost the postural balance.

Difficulty to achieve equalisation, for me valsalva doesn’t help much, but acting too much stress to the tympanic membrane. By swallowing and opening the Eustachian tube works best for me, yet its not easy to swallow in the water while biting on the second stage.

Sand/ dog/ larva/ cutaneous migran

Day 0: the trip to BKK

還是想盡全力去記下旅行中的心路歷程,儘管我知道,在這日後幾天的時間裡未必能夠保持有這種與自己的心靈對話的集中力。或者,亦都應該感謝咖啡因所帶來的這短暫的空靈感。感覺相當奇妙呢,我在想大概每一次出發到外地時候的思考與心智都很不同,或者可以描述為變得更成熟,但又可以說成是失去那再年青時候的那種興奮與充滿玩味的心情。現在的自己反而多了一些對於所聽所見的事物,那當中的背後的思考。好像就在剛才有一幕flying attendants 在推著餐車去送遞食物,我留意到那一男一女的fa, 會去思考他們的打扮。那個rainbow poon 的酒窩很可愛,人是高高瘦瘦的感覺,左手中指帶著指環。在她成為fa 之前,她有做過其他工種嗎,那裡頭又有甚麼經歷呢。那個大大隻的男fa, 樣貌有點似tom, 不過這個他好像化了點妝,塗了唇彩。

港航最Typical 的腸仔包。味道不錯,面包有一些位置乾乾的,很脆口,口感很有趣。

腸仔包味道的 女Fa,真可愛

抵埗後,機場燈光比較昏暗,不過亦意外的不算冷清。要記得那個時候是凌晨近三時許。不過附近的中國人還真不少。Thai as an extension of PRC, 到處都是簡體中文標示,其中一個思考就係是否因為中國旅客實在太多,而且都傾向是不守規矩大大聲講說話的一群人,不讀英文,於是只能對他們屈服,因為不想受到太大損耗。最令人嘔心的是,連廣播都是普通話。真可笑。我記得先前好似有新聞談論到有國人在泰國被中國政府擄走。

第二名失蹤者是「巨流傳媒有限公司」股東桂民海。桂民海於2015年10月17日於泰國芭提雅公寓被一名男子帶走。其後桂民海曾三次致電其公寓大廈物業管理處報平安,表示自己正在「弄電腦」,但未有透露所在地。他最後一次與物業管理處聯絡是於2015年11月10日。(Wikipedia, 銅鑼灣書店股東及員工失蹤事件)

3.8+ baht – 1 hkd in airport =V=

一個獨男來到曼谷到底為了甚麼?

Day zero part 2

離開gold airport suite, 鼓起勇氣去問前台交通情報,不竟於位置荒蕪的地方,實在插翼難飛。雖然早早check 過 rome2rio, uber,grab 之類。原本還以為真的要坐的士,因為前台職員appeared to have no idea about the transport. 不過好在做過功課。

在Golf bus路上同酒店哥哥吹水,問我由那裡來,是否from china, i said no, from hong kong. 然後就打開了對話盒子,佢不斷的重覆著“你好”,就似我那時候到cambodia 一樣。後來一齊數中國旅客 “機場”

黃色面包車。

Should never travel to bkk on sunday! Poor currency exchange rate hkd 1 = thb 4.31… Even better in the airport.

morbidity and mortality

in ICU, we have fewer cases to handle, but we offer maximal care that one could offer to those who are in need. still there are cases which we are not able to salvage, for example those who are in really bad with impending mortality, and those which curative management was not available at the time of diagnosis, due to whatever reason.

please never forget about the man who had anti-NMDA encephalitis, who presented with subacute onset of confusion, with florid frontal lobe symptoms, followed with increased in stupor, respiratory distress, and most importantly, excessive orofacial movement and dyskinetic movement of limbs – seizure mimics. the prognosis could be poor, as there is no specific therapy that could be directed to the condition. intravenous immunoglobulin may not be suitable in case of high fever. and even with plasmapheresis, many of them still remains in that poor condition. those who have an identified source of neoplasm/ malignancy might or might not be benefited from resection. young women with benign teratoma, classically.

never forget about the case with open pulmonary TB being undiagnosed for years, with poor respiratory reserve and emphysematous lungs. in case of respiratory distress, please actively look for any pneumothorax. also to have a look on the blood gas to seek out which type of respiratory failure it is. be it type I, or type II. if you miss a pneumothroax and connect the patient back to a ventilator, you are creating a positive pressure ventilation which definitely worsens the chest condition and leads to lethal tension pneumothorax. in case of hypotension and shock, always classify it into which type of shock it could be – cardiogenic, or non-cardiogenic (which can be distributive, hypovolaemic, or obstructive), pneumothorax and tamponade should be recognisable. always think about the 5Hs 5Ts which have been taught in ACLS.

ACLS is useful. follow the secondary survey, ABCDs.

drowning lady. only fifty odds. failure to achieve adequate oxygenation despite high PEEP and high FiO2. bronchoscopy might only be helpful in those with obstructive lesions, and had limited role in aspiration, but risking the patient to de-recruitment. check the airway with DL, or FOB.

ischemic bowel por-por. i felt really helpless to her condition, despite what i could offer, including inotropic support, fluid resuscitation, taking over her airway and breathing by IPPV. if the surgeon is not doing the things, what could i do? i mean, how should i have done to strongly influence and persuade the parent team?

last long night, in BPT. then, to koh tao!

一段自我剖白

其實,關於結果,我早有了預感。我嘅insight 第六感好少錯。呢一段療傷的過程,早早已經開始左起碼半年,只不過我還是有那麼一點不心息,然後終於在昨晚的一段簡訊裡,得到了不能更明確的回覆,而我亦親手為自己的dead cert上,蓋上印章。成年人世界,大概不需要故意不相往來,時間與地域,會漸漸讓人疏離。我大概只需要不刻意的去關注那個人的事,稍為杜絕社交媒體,也許不消幾個數天,他就會在我的腦海裡灰飛煙滅。像過去的任何一個,曾經讓我刻骨銘心的每一個她。

但心情低落還是免不了的,那種dull compressing chest discomfort, associated with apneic feeling +/- involuntary Valsalva maneuver. 腦裡頭響起的許多Negative cognition – 想去搵出或者覺得自己有地方做錯,於是又落得這一番田地。幾個月前讀過一些文章,這種feedback response 大概是童年時候所養成的。於是我變得好aware 呢樣野,亦知道要花一些功夫,either to solve it, or to get over it.

給自己的死刑的確不好受呢。大概是剛巧雙方都在不同的環境裡攝取解一些酒精,然後說話都少了顧忌。這也好。這才是對話。

把一個人粉碎後再重來,我相信這次的復修會快一點,更完好一點。

但問自己在這一年的追逐裡,我還是有一點成長的。我會開始去注意personal growth, 去主動了解兩性互動的dos and donts. 我知道自己會成為一個更好的自己。感謝,妳的出現。

Potential

What candidate are they looking for?
– knowledgeable of medicine
* Where we are from, our potential now, we are heading to
– willing to serve
– understanding and empathetic to humankind
– caring person
– self learning
– communication with patient vs technology
– experience of physical/ emotional suffering, stress and anxiety
– chronic disease, end-of-life issue