A Traditional Christmas

After three flights in 30 hours, and a 2-hour drive at manic speed across the Austrian border, we have finally arrived home for Christmas. When I say home, I mean hubby’s family home in Eastern Europe. Although this is definitely not the first time I have spent Christmas with the in-laws, this place is a vast contrast to our home in Australia so I still need to switch on my adjust button whenever I come here.

On arrival, Mamka would laugh in genuine delight at the sight of her first born, one that she has not seen for far too long. Amongst the excitement, 87-year-old Babka would lift herself out of the chair, making sure no one notices her difficulty. The traditional three kisses on the cheeks are exchanged all round, and as usual, my cheeks are patted by weathered hands for good measure. A rowdy exchange occurs between the two brothers; they slap each other’s backs amongst verbal insults. M and I take off the layers of our winter gear, while his brother mumbles at the weight of our luggage as he drags them across the threshold.

M’s mother, grandmother (or Babka as she’s fondly known), and 34-year-old brother live in an apartment in the town centre. This is a 2-bedroom apartment that has not been touched since the 1960’s, the whole floor plan would fit easily into our lounge room. It would be unheard of for us to stay elsewhere when we visit, even though his brother has to move out of the second bedroom onto the lounge room sofa to accommodate us. The décor of the apartment has not changed since M’s parents have gotten married and moved in in the early 70’s. Old cupboards in orange pine lacquer line the walls, each with scratches and peeling edges. The shelves are bent in the middle under the weight of timeworn books, vintage ornaments and items of all sorts for the last 50 years. Childish stickers adorn the glass panels of these cupboards; old photos, trophies and toys line the benches, all live documentations of his childhood.

The apartment is in desperate need of renovation. The toilet flushes but does not rest evenly on the floor, thus it rocks if one sits down on it with full weight. The small balcony off the kitchen French doors shows cracks in its concrete floor, barely strong enough to hold any human weight but serves as a perfect spare fridge/freezer in the cold winter months when the outside temperature is barely above 5 degrees Celsius. The bathroom holds a bathtub that is as old as the apartment itself where one still has to shower the old fashion way – sitting, soaping one handed whilst wrestling a shower head with the other hand. The stove and oven is one that is only seen in a museum nowadays with iron holders and old racks. The sink is barely large enough to fit a soup pot; old plastic drying racks rests on top of a laminated bench. What dishwasher? I would have gladly purchased one for them, but not only is there no space for such a luxury, but they do not actually have the appropriate plumbing to fit one.

The ‘second’ bedroom really is the front sitting room and part of a passageway into the main bedroom (which is shared by mum and grandma), thus there is no privacy to speak of. Babka lies in her bed most of the day, watching soap operas with the volume dialled up, as she is not one to admit to the need for a hearing aid. Occasionally she ventures out of bed for the essentials, one of which includes a cigarette and a glass of beer every couple of hours. It is a regime which prevents pressure sores and satisfies her curiosity as to what everyone else was up to. She never goes outside the apartment anymore; the osteoarthritis in her knees prevents her from walking more than a few steps at a time. A cane sits stubbornly ignored by the door and whenever her knee is mentioned, she would hold onto the cupboard and do a little jig just to prove that it is all a figment of our imagination.

Everyone smokes continuously in this household, everyone, that is, except us. This is irony at its best considering M is a heart and lung surgeon. Cigarette smoke constantly permeates the whole apartment, which then infiltrates into everything in our luggage, a reminder of our visit when we move onto the next European destination. Opening windows to air the apartment is never an option, as the bitter cold of European winters, when permitted to slip inside, renders the heating systems ineffective.

It is not uncommon for us to escape the apartment with long walks, the biting wind and icy footpaths a better alternative to the indoor haze. Once rugged up, with gloves and a rubber soled boots over wool-covered feet, we would tackle the local hill up to the township castle, or trudge by the icy river at the base of the retaining walls. Two hours of fresh air not only flush out our smoke-ridden lungs, but also brings sanity back after being stuck in a small shared space. Hubby is often silent on these long trips, as he takes a rest from being bombarded, not only with the latest local gossip, but also with questions about the latest developments in his life from his mother and grandmother. This is also a time when he enjoys a reprieve from being the translator between the three women in his life. It is a concept that the older women do not seem to understand as they continually talk while he tries to translate to me, until he gives up – usually by the end of the first day of our visit, at which time they berate him for not involving me in their conversations.

Breakfast is not for the faint-hearted here. Mamka would get up around 7.30am. She sits down at the vinyl covered dining table, leisurely enjoys her first cigarette before her preparations. An hour later, we would wonder in, with hubby being in charge of the coffee and I, in charge of toasting sliced bread. Once everything is placed on the small dining table tucked in the corner of the closet kitchen, Babka shuffles in on her slippers and in her pyjama dress. The first meal of the day starts with a shot of Vodka or Cognac, of which she knocks down in one toss with a big satisfied sigh. A black coffee is then savoured with toast and homemade spread. The spread alternates between the fishy one (a blend of sardines, mackerel, mayonnaise, butter, and mustard), or the cheesy one (a beaten mix of blue cheese, beer, butter and seasoning). This is accompanied by freshly sliced brown onion, radish and strips of paprika. Often with a look of disdain from Babka, I stick to my jam or marmalade on toast. As I daintily chew through my breakfast and sip my coffee, I would recognise the word ‘princess’ in conjunction with my name as she comments on how I eat ‘like a sparrow’. Once breakfast has been consumed, a cigarette is then lit, accompanied by a shared bottle of beer. As an excuse to get away from the fumes, I would volunteer to do the dishes. In reality, it is not the meal which bothers me. No, it is the burp that comes out of hubby about two hours later when we are on our walk, when he decides to steal a kiss, at which time a rumble starts in his stomach and releases as one toxic explosion in my face. One might think I am swooning at his kiss, but I can assure you that it is no other than the stench which permeates my nose for the rest of the day.

Christmas here is celebrated on the 24th, at four o’clock in the afternoon, as the winter sun descends rapidly behind the hill, we head to the town cemetery, armed with bags of candles, matches and fresh greenery. The place is full of people and constant traffic passes by the gate. It is an exercise that may take time depending on how many friends and acquaintances Mamka runs into. At every visit, we hear the story of whom each graves belong to, and stories of the deceased. Candles are lit, the marble headstones are cleaned, and the greenery is laid on each family grave. She mumbles a prayer quietly and we move on. The walk home is usually filled with peace, places of interest are usually pointed out. This is where M went to high school; that way is where Mamka used to work, and this is the road that leads up to Babka’s old house.

Dinner is usually served around seven, in the small lounge room that barely fits a sofa, two lounge chairs and a rectangular glass coffee table. His brother is made to remove his pillows and blankets, and he is in charge on turning the lights on the Christmas tree. The smell of fresh pine leaves from the tree cuts through an odd mixture of stale cigarette smoke and evaporated oil of deep-fried carp in the lounge room. Family crystals, silverware and porcelain are laid out on Christmas-themed table clothe. A round of Vodka or Cognac is shared as a toast to health before the meal starts. Grace is spoken, with blessings bestowed on all at the table, where Mamka paints a cross is on everyone’s forehead with a honey-soaked garlic clove. This is rather troublesome for one who sports a fringe such as myself – for the rest of the evening, I have to try and ignore the discomfort of having my dark locks plastered to my forehead, not to mention the slow descent of excess honey into my eye lashes and my nasal tip as we work through the courses.

Entrée consists of poppy seed pudding with poppy seed coated prunes. Once we are floating on poppy-induced Christmas cheer, the fish is served with a potato salad. Beer is consumed like water, and one is never allowed to rest on an empty glass. As we munch through our meals (eating carp is never a graceful affair), we again listen to both older women tell the story of how each dish came to be part of the Christmas tradition. It was an eclectic mix of the two families. Your father’s family didn’t like fish, so they always had cabbage soup. We never had the prunes coated in poppy seeds, that’s something your father’s mother brought into the house.

An apple is cut by grandma after the mains, and if a star is found when sliced in half, it bodes good luck and prosperity for the new year. It therefore doesn’t take a genius to figure that the apple need to be cut perpendicular to its core, although it can be nail-biting in case worms are found in a rotten fruit, disrupting a perfect star-shaped core. Dessert is a self-serve affair, consisting of chocolates hanging from the Christmas tree. Sometimes this could be a little sparse when the sweets mysteriously vanish from the branches during the days before Christmas Eve. Mamka however always have a spare stash for such an emergency, of which she hides in the TV cabinet next to a large collection of DVD’s until required.

Presents are given and opened before the stroke of midnight. Each person is given the attention and time to open their presents and thank the giver. By now if the poppy-seed doesn’t make one happy, the beer would make one exuberant about any present, no matter what it may be. Without doubt, Babka would run a dry commentary on each present revealed whilst happily nursing her umpteenth glass of beer in the large lounge chair.

This is Christmas. A tradition that my husband has shared with his family since he was born. A tradition that makes me grateful to be a part of when I am here, as a member of this small loving family.

Vesele Vianoce to you all.

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Just a R&R on Allergies

allergies

Humour me – I need to do a R&R (Rant and Rave) on patient’s allergies.

I am sick of people with ridiculous allergies.

My anaesthetist once told me, that if a person put down more than three drug allergies, then he/she is most likely crazy. I have had patients who ran out of space on their pre-consultation questionnaire for their allergies that they started to list them on the back of the form. I understand that there may genuinely be people who have multiple allergies, but these people are extremely rare. Their allergies are often proven with forma allergy-testing.

I have had patients who have listed every class of antibiotics under their allergies, so I have had to tell them that I couldn’t operate on them, because if they got an infection, I won’t be able to treat it.

Then there are the patients who put down ‘allergic to general anaesthetics’ when they check into hospital for their operation. Really? Would you prefer a sledgehammer instead? You can’t be allergic to general anaesthetics – to put someone to sleep it requires a finely-balanced cocktail of different intravenous drugs and inhalable gases. Sure, there are known idiopathic reactions to specific anaesthetic drugs, but these are rare – often the specific agent can be identified and the patients are informed in detail. The generalisation of being allergic to general anaesthetics just shows patient’s complete ignorance to their true allergies. Nausea and vomiting or a mild rash after a GA is common – it doesn’t mean you are allergic to it.

Patients who are allergic to multiple pain killers are a complete headache to surgeons. When patients put down that they are allergic to all narcotics except Pethidine, they shouldn’t be surprised that medical and nursing staff treats them like Pethidine addicts. Pethidine is a narcotic, it’s hard to fathom that someone could be allergic to all narcotics but not Pethidine. Most often, people who get a high on Pethidine prefer Pethidine injections to any other narcotic as their pain relief. There are also patient who claim they are allergic to simple analgesia like paracetamol/acetaminophen, or anti-inflammatories, but can only take narcotics. That to me, also sounds pretty suss.

Then there are patients who think they are hilarious. When I ask them what they are allergic to, the response is, ‘doctors’, or ‘pain’, or ‘hospitals’. If only I had a penny for each time I get the funny patient, I’d be a millionaire by now. What about patients who write ‘hay fever’ or ‘eczema’ in the box next to ‘Drug Allergies’. Really?! Do they know of any doctors who prescribe ‘hay fever’?

Food allergies, however, are important to disclose, as some people who are allergic to seafood or crustaceans can also be allergic to iodine. One of the intravenous anaesthetic (propofol) also has egg protein in it, so can cause severe allergic reactions in those who are allergic to egg. As for being allergic to cat? Well, we don’t normally prescribe cat, and the well known cat-gut sutures are actually made out of sheep gut.

People need to understand the difference between side effects and allergy. Nausea, indigestion or even itch sometimes, is not an allergy; it is just a common side effect. These side effects can be avoided if advice or treatment is sought. Being sensitive to something is not an allergy. Patients love telling me they are allergic to all tapes.  When tested, they are usually not allergic to any, because the ‘red rash’ they describe are just irritation from the sweat which has accumulated under the tape on their sensitive skin. Some people are also quite ‘sensitive’ to medications, and although understandable, is still not a true allergy. All that is needed is a dose or timing adjustment or even treatment to prevent these sensitivities.

Sometimes I have to admit, it can be the doctor’s fault that patients think they are allergic to numerous things. When a patient reports a side effect, the doctor is often quick to blame the drug and put it down in the allergies column, instead of explaining to the patient that it is not a true allergy, and find out if the drugs were taken correctly.

Why is it so annoying to a doctor when patients put down allergies which are not true allergies? Because once you have written it down as an allergy, medicolegally, we find it very hard to give that particular drug to you, even if you need it desperately. So if you put down that you are allergic to an antibiotic when all you get is a bit of nausea, we have to give you a second-line antibiotic choice to treat your infection because we don’t want to be sued for drug reactions. If, instead of putting it down as an allergy, you tell us that you get a bit of nausea with the antibiotic, we will dose it so that you can take it with food and maybe some antacids to treat the side effect, but you will now get the best antibiotic for your infection.

So next time you write down your allergies, think twice before you start listing them.

What about the patient who told me that she was allergic to light?

I told her that it was ok. I can operate in the dark.

 

Smoked Salmon

It was after a very long day at work.  A complex operation that took me ten hours, standing on my feet, without a break.

I was so tired I was almost asleep by the time my car rolled to a stop in the garage.

Dinner was served to me at the table, lamb racks, fresh boccoccini, tomato and basil salad. My husband and I ate silently. I was too tired to evening lift the fork to my mouth, let alone make any intellectual conversation.

‘Is dinner ok?’ He looked at me in concern.

‘Yeah.’ was my half-hearted reply, pushing a piece of cheese around.

‘Don’t you like the salad?’ he asked, almost defensively. ‘I thought you like it, that’s why I made it.’

‘No, no, I like it.’ I said, too tired to argue. Which obviously came out pretty unconvincingly.  In actual fact, I did, and I do. It is one of the salads he makes which I love. I was just too tired.

He looked at me suspiciously.  ‘Are you just saying that or do you actual like it?

A pause, then he asked in a slow, deliberate tone, ‘Is it a smoked salmon?’

Ever since the ‘smoked salmon incident’, I have lost my husband’s trust in my ability to tell him the truth of what I like and what I don’t like.

It happened two years ago. At the time, he was working in the UK, and I was visiting him. He was working night shifts, and because he needed to take the car to work and was living quite far out of town, he made sure there was plenty of food in the fridge for me before he left for work each evening. A week down the track, he was cleaning out the fridge and noticed there were packets of smoked salmon sitting on the top shelf in the fridge.

‘Why aren’t you eating the smoked salmon? They are nearly out of date.’ he asked me. ‘I bought them for you.’

I walked over to the fridge door and looked at him in confusion, ‘but I don’t like smoked salmon.’

He looked me incredulously in return. ‘Are you telling me,’ he said in a dangerously quiet tone, ‘that after 18 years, I am just finding out that you don’t actually like smoked salmon?’ A deep breath. I could almost see the pressure increasing behind those grey eyes. ‘Why haven’t you told me before? Whenever we are at the supermarket, you just let me buy packets of salmon!’

‘Because I thought you liked it.’ And I did.

‘So what did you do with all the packets of smoked salmon we used to buy?’

‘I had to keep throwing them out because they were out of date. I was wondering why you kept buying them and not eating them.’

‘Because I was buying them for you. I thought you liked them.’ By now, I was sure the neighbours in the next apartment has their heads under their pillows.

And so there it is. Smoked Salmon. I had to tell him, after 18 years of being soul-mates, that….. I. Don’t. Like. Smoked Salmon.

The truth is. I don’t hate smoked salmon. I will eat it if Í have to, or if there’s nothing else to eat. But I don’t deliberately go look for it, or seek it out. If there was a choice on the menu, it will not be my choice.

It took me a while to realise why I have never bothered to tell him I don’t like it. It was simply because I thought he liked it. And similar to most couples (who, like us, have obviously been together for too long), I sometimes end up doing things or making decisions to please him, because what makes him happy, makes me happy, and most of the time, it wasn’t worth the effort to debate about it.

Unless it’s something I really hate. Like Golf. I drew the line at Golf. He was on his own for that one.

So when he refers to a ‘smoked salmon’, he is basically referring to his lack of trust in me to tell him the truth about my preferences. He is now constantly suspicius that I do things or make decisions to placate him. I am working on regaining that trust – which I did have for the last 18 years until that sudden moment of enlightment at the fridge door.

But most importantly, for me, a ‘smoked salmon’ is a reminder that I need to be truthful to myself, and trust that even if I don’t like what he likes, he still loves me.