Angels of the Sea

Whales are creatures of the ocean,
Teachers of gentle motion,
That allow us to see,
The meaning of “being free”,
For they are the angels of the sea.

14-10-15 Another week, another rotation, and a week closer to the final exam of emergency medicine. I usually find starting a new rotation is stressful because at the beginning it’s hard to know all the ‘ins and outs’ of the job. This week was no exception, except I was blessed by being supported by some wonderful colleagues, especially my intern Kate who had such a positive outlook on medicine and life in general!

After feeling so tired from the week just gone, spending extra hours studying for my emeregency medicine fellowship exam which I will sit in February 2016, I decided to catch up on sleep and skip the opportunity of a morning surf. Instead, Sanna and I decided to go to our favourite café in Thirroul to have a coffee and do some study. However, before sitting I felt a strong calling to first go for a ‘nature break’. As far as my logical mind could reconcile, this venture was going to be a walk to the ocean, for the purpose of gaining some inspiration before going back to practicing exam questions.

When walking down to the Thirroul beach I saw that familiar splash in the distant ocean that always makes me think “is that a whale?”. My knee-jerk reaction was to say to Sanna “Hey I think I just saw a whale! Did you see it?”. She usually discounts such suggestions because I forever seem to be saying, “hey I think I just saw a whale!?”. Sanna has grown to be slightly dismissive about these suggesions, but the great majority of times that I’ve suggested this it has turned out to be correct. I keep seeing them and they keep appearing in my life. Today was a case in point.

When we got down to beach front, I went straight to edgy and we could clearly see at least two maginificent playful whales periodically jumping out of the water creating quite a splash. It was an amazing scene to encounter. No matter how far away, or close, one is to a whale in the wild, it is a magnificent thing to be around them. Interestingly the previous night I had a beautiful dream where I saw a humpback whale jumping out of the ocean in full breach. I had forgotten about this dream – but it seemed to have come true~!


A Proposal and Engagement: with imagination, hope and love!

A poem, flower and a ring,
Holding this within our heart,
Even the peasant becomes a king,
Through the land of enchanted love,
Rising above cloud and rain,
Moving beyond the insane,
This is where dreams are made,
Where dues are paid,
In exchange for the hope of “imagination”.



A few days ago I asked the woman that I love to marry me. She said yes and now we are engaged. We don’t even know what this fully entails. Apparently in Swedish culture, upon discussing this with some Sanna’s family here in Sweden, it is more traditional for both the bride and groom to exchange rings at the time of engagement, and it is only the bride who gets a wedding ring (Hang on a sec! That means we’ve done this backwards as I’ve just given a Sanna a ring, and I figured we would exchange rings at some point in the future when we get married?).

I had no idea of the particulars of how one should propose to a Swede, many questions crossed my mind, like whether I should ask her father beforehand, or even what would be a good thing to say? In fact the only ones who really knew on my side were my two brothers back in Australia and New Zealand, whom I told of my intention at the beginning of the year. However, in terms of this proposal I needed some specific help. Lucky for me, I happened to sit next to a man who looks about my age on the plane from Brussels to Stockholm, who also originated from outside Sweden (ie in Portugal) and married a Swede. I learned from him the Swedish words for “will you marry me?” which gave me much needed confidence in the secret mission that I was about to embark upon, however, this lesson was followed by a subtle warning that if I was not careful with my pronunciation I could easily be stating that I wanted to be poisoned! I thought about telling him that this was a bit ironic as I had recently been awarded a PhD in the field of Toxicology (poisoning) – but perhaps this was going sound a little strange, so I just made a mental note “say “Vill du gifta dig med mig?” (pronounced Vil-du yifta-day-med-may)

The actually proposal was like magic, I had to keep it all secret as I figure I didn’t want to tell anyone. The perfect spot on top of the lookout at Trysunda island where Sanna visited regularly growing up, which was also one of my favourite places on the planet. But still there was so much doubt, with the ring in my backpack, the words in my head. My mind was riddled with a series of “what if” type questions, as it easily can be when taking important decisions about my life. These worries are all to do with the future and completely ignore the wisdom of the present.

Lucky for me the skill of meditation and the craft of writing are two things that came to my rescue in a time of need. A short sit, and a little bit of journal time in the boathouse on Trysunda Island created the space to connect with my heart. It was clear to me in that moment that there really was no right time, So on this occasions, as with almost all the most significant decisions that I have made in my life, the answers have come from within, only if I dare to ask.

On Facebook it looked like a fairytale proposal, and it really was looking back, but what is not shown on these made-over social communications channels like Facebook are ally the not so shiny bits. In addition to the normal fear and trepidation that had to first be overcome, which of course included the fear of her saying “no thanks”, the morning rain had set in. However, I was determined to go for a walk, rain or shine and share a morning moment with Sanna. For some reason in that moment the Angels were showering there blessings upon us and the rain cleared. The was just enough time to pass on a blue-bell flower, and read the romantic poem that I had written the night before, followed by a ring and my line in Swedish (quickly followed by the English translation to avoid any incorrect assumptions). Well let’s just say that she said “yes”, we were elated, and I was very relieved and, well, the rest is history as they say. It seems now, even after a few days that it was so the right thing to do, and all the doubts and fears seemed to quickly disappear into the Trysunda mist.

Leaving Sweden! “Tack” for the wonderful time :)

It is with great gratitude and joy that I now look back on the wonderful week that we have both experienced in Sweden. However, now we have to drive to the airport and say goodbye to those we love and care about. Whilst I know we are not alone in this all too common problem where families are scattered around the country and globe – it still doesn’t make the separation any easier to take.

When I reflect upon the trials and tribulations of even the most happy occasions in life, such as getting engaged – perhaps the real magic lies not in the sun streaming down from the skies when a ring is held out in front of the one you love, but in the ability to see “beyond the clouds” and focus on gold that is always looking at you straight in the eye.

To all our family and friends who have sent such warm congratulatory wishes in phone calls, emails, and in notes on social media. Thank you from the bottom of our hearts.

We don’t know much about when, where or how the wedding will be, but all will become clearer in the months to come. Let’s just say that we both strongly believe that “life is an adventure”, (albeit with plenty of ups and downs), so at some point in the future we really hope to be riding that wave called marriage!

Lots of love from us both!

Love is awareness… (the travellers mindset)

Love is awareness,
The I don’t-care-ness,
That blesses those who awaken,

To the voice inside the whole,
Perhaps, the seat of the soul,
If such a thing exists?

Observe and see what persists,
The truth that sometimes resists,
Only waiting to be uncovered.


I’ve have just travelled in a plane from Sydney for 14 hours and right now am on a 3 hour stop-over in Abu Dhabi. So much has happened in the last 24-48 hours; finishing up my last shift at the emergency department to go on a much awaited 2 week break, graduating from a 9 year journey in research, followed by embarking half way across the world to be reunited with the woman I love. I have only been in Abu Dhabi for 1 hour but have noticed myself slowly slipping back into the mode of the “traveller mindset”. It is in this space that I have recieved much inspiration throughout my life.

The most incredible things have happened to me whilst travelling. I used to think that actual “physical travel” was necessary to get to this state, that is, until I discovered surfing and meditation. I have realised that travel is as much a state of mind as a state of being and cirucmstance. For example, the fact that I am now “travelling”, is more than a “situation” that has arisen by working in a job, booking leave, and then jumping on a plane to travel to a specific overseas destination. What I’m experiencing, and viewing through my mind, even before arriving at my chosen destination in Sweden, is far more than the situation of arriving at the destination. The process, that I have grown to know and love has already started.

Here in the airport transit lounge itself I have noted myself experiencing a state of total immersion in the essence of travel. I feel the sensation of arid heat upon my face as I look through the terminal glass out a the airbus’s and parked boeing aircrafts, standing on sunbaked tarmac, surrounded by a haze of dessert dust. I can hear the CNN, american accented, newscaster talking about reports of terrorist attacks from TV screen above and behind me, whilst sipping a latte that tastes quite different to what I am used to; perhaps it’s the different coffee bean, or the dairy product that is not quite the same? All these thoughts and sensations are in constant play, keeping me entertained and alive.

In amongst all this I have again embraced the interesting social dynamic of travel, where I can easily engage with other random travellers about a number of things ranging from travelling tips, to the reflections about deeper aspects of life. Since jumping on the plane at Kingsford Smith International airport in Sydney last night, I have already met a gentleman in his 50’s on his way to Athens, who shared the wisdom of his life experience including the assertion that if one believes and focusses on anything it can be achieved, and the refelction that by far the the most important thing in this life is family. Then there was the lady traveller from returning from India to Brussels with a colourful clothes reflecting that cultures of subcontinent, and the young Russian lady who sat next to me whilst having coffee, reading “eat, pray, love”, just about to embark on a travel adventure that included Thailand and other neaby South East Asian countries.

All these experiences perhaps occurred because my consciousness was not dulled by a circulating and never ending list of “tasks at hand”, something that seems to characterise modern urban living.

Travel encapsulates the everything that is occuring, the body sensations, the sights, the sounds, the human interactions, all being noticed indiscriminately, with curiosity and sometimes with bewilderment and awe. To me it is this observational mindset, which I call the “travellers mindset”, that is at the heart of travel.

IMG_4057 IMG_4056 IMG_4052 IMG_4049

Dear doctors, be kind to each other.


Kindness is Key!

This blog post by Dharmaraj Karthikesan is like pure gold – laden with courageous statements that ooze of wisdom! (like the one quoted below) thanks Dharmaraj :)

The health profession needs more docs like you!

“We often excuse doctors who are bullies because they are ‘great with patients’ and are ‘brilliant clinicians’ or ‘gifted surgeons’. This hurts the profession more than you can imagine.”

read on ….

Originally posted on Dharmaraj Karthikesan's Blog:

I met a young doctor who used to work under me recently. I had just completed my night rounds in the hospital and I was leaving for home.

And then I saw him. He was unkempt, exhausted and appeared famished. Worst of all, he looked like a man who has totally given up on being a doctor. He appeared hesitant when I asked him what was wrong, but I could not just leave him there.

After much persuasion and insistence on my part he agreed to join me for a late supper. While he ravaged through his first proper meal of the day, he finally opened up. He has started working for the past week in a new speciality. Though the hours are longer, it was not an issue. He was well aware of the sacrifices he was expected to make.

However, the degradation, humiliation and constant harassment have finally taken…

View original 1,731 more words

Emergency medicine, and the loophole of love!

the loophole of love

With love we rise above,
Like the angel to the dove,
That flies high in the sky,

Above the the question of “why?”,
This should happen, or that should happen,
Instead taking “acceptance” as the key,

For only then will we be free,
From the visitudes of life,
For these are the ones that give it the spice,

Like a curry to its rice,
Remembering that there is no price,
In dreaming away,

So forget what “they” might say,
Because inside we can continue to pray,
For the gift of smiling yet another day,

And loving the present moment,

For in the end,
It’s all we have.


I recently started a new rotation of Emergency Medicine training, and before long have found myself immersed in all it’s beauty and simultaneous horror. Our speciality is full of energy, love and frustration. There are good days and challenging days, magic moments and equally frustrating ones, often intertwined into the same 10 hour shift, if not the same hour.

Most days are heavily mixed with both energies which makes it hard to have a frame of reference for an answer when someone from outside this world asks, “so how was your shift?”. For me, it is perhaps most truthful to answer this question with a guitar in hand. An example of this is provided with the the song titled “in the night drift”, that I have included at the end of this post.

Often the pressures within a single shift are high, but when compounded within a persons training period, or across sections of their career span, it is understandable that a soul searching doubt can easily set in, to the point where the question of “why am I doing this again?” is asked.

I am sure that this question gets asked by many in the field, perhaps with haunting frequency, regardless of whether one is a nurse, doctor or any of the multitude of other health “carers”.

Doctors, nurses, and the many other important ones

Whilst most would argue that “doctors and nurses” are at the core of health care provision, there is an array of other people, who occupy either named professions or unnamed roles. These people often contribute under the radar of recognition, but are making a huge difference in the field of emergency medicine everyday.

The list, in no particular order, includes but is not limited to;- physiotherapists, radiographers, clerical staff, nurse aids, cleaners, porters, special care assistants, pharmacists, translators, administrators, radiographers, laboratory staff, parking attendants, building engineers, ambulance and police staff, public health workers, aged care workers, counsellors and social workers, and not least the patients themselves and their families. We are all one, interacting together, in the common milieu of a single shift on the emergency medicine shop floor (a term that is often used to encompass the Emergency Department by Emergency Physicians in Australasia).

Why we practice emergency medicine?

Regardless of whether one is a doctor or has one of the many other important roles in this arena, perhaps Mel Helbert puts forward one of the best expositions of why someone would consider undertaking a career in emergency medicine in his recent talk titled from the EM essentials conference titled “why we practice emergency medicine”.

Mel, is the creator/founder of the EM Rap education channel, is a champion in emergency medicine education. When I use this term I mean it both literally, but I also mean to use it as a term from the field of “knowledge translation“, used to describe those who are proponents of change, in the evolving culture of crossing the “know-do” gap.

Whilst everyone’s story is interesting in their own unique way, Mel seems to have captured with his unashamedly honest exposition something that reaches out and inspires his audience, no matter if you love it or hate it, are within or outside the profession, or are simply curious about why anyone would want to do this job.

It was a really interesting 15 mins so I thought I’d share it here – thanks Mel!

The night shift

As promised, this is a song called “in the night drift” that I recorded directly after surviving busy nightshift, when I crawled back to my hospital accommodation and had a much needed sleep (albeit after a date with my guitar!). Enjoy :)

A PhD thesis in knowledge translation: Improving medical management through research and training

When I tell people that I have been doing clinical research for the better part of my last decade of life I usually get a few or more of the standard questions that are asked of higher degree research students like, “what did you do your PhD on?”, “what did you find?”, “was it hard?”, “why did you do it?”, and “what’s next?”.

These questions can be asked in a matter of seconds, but to answer them even briefly can take from 15 minutes to hours, depending on the level of interest. Now that the PhD is finally wrapped up, I feel inspired to write down some of the answers to these questions. I write in the spirit of what my thesis was all about “knowledge translation”, in other words, getting research off the shelves and into practice.

What was your PhD thesis on?

The title was “Improving the medical management of organophosphorus poisoning (OP) throught health services research and training”. Self harm is a big problem worldwide, and anyone working in an emergency department will be no stranger to this problem whether it is from people cutting themselves or taking overdoses. In many parts of rural Asia people drink pestices as a means of self harm resulting in over 300,000 deaths annually.

The vast majority of these pesticides are a particular form called organophosphate agents. This is much more toxic that the common weed killers used in Australia, such as round-up which is a glyphosate, and organophosphorus agents result in high case fatality rates, in the order of 15-30%, despite best practice.

The research collaboration that I worked with to conduct my research, the South Asian Clinical Toxicology Research Collaboration (, was a project that aimed to address many aspect of the public health problem of pesticide self-poisoning.

My work focussed specificially on two areas;

1) Improved medical management through the use of point-of-care tests that could provide information (acetylcholinesterase, ACHE, levels) that was thought to be useful in guiding antidote therapy
2) The evaluation of a train-the-trainer system of education to address training deficits in resuscitation education in the rural Sri Lankan setting

Both of these streams of study were different vehicles on the same journey of aiming to close the knowledge practice gap surrounding the management of OP poisoning. Thus the overall theme of my thesis was to do with this process of “knowledge translation”. The studies have been liked together using this conceptual framework.

They say a picture says a 1000 words so perhaps a figure from the introduction section of the thesis of the conceptual frame work , and two figures from the conclusions sections would aid to this strategy (ie 3000 words!?)



fig 3

Was it hard? Why did you do it?

These two questions are perhaps best answered together.

Yes it was hard.

I did it for multiple reasons, but most of all, it was the journey of trying to make a difference in the world. I have always wanted to do this, and when I started doing educational research I realised that there is an immense potential to improve the world by creating, and then assessing different systems of education.

The following video/slideshow shows how this happened in a poetic format.

The course of the PhD offered many challenges for my Emergency Medicine training that I was doing concurrently, as well as the ups and downs of life.

However, despite the knocks and triumphs, I strengthened my resolved to follow the dream I initially had with making a difference through training in Emergency Medicine training and International Research, and so far it has paid off in ways that I cound’t have imagined.

What’s next?

The first step was to stop, appreciated, and then reflect upon lessons learned, and wisdom gained that will hopefully help myself and other in the future. The next step is to become an Emergency Medicine consultant by finishing off the training, through training and sitting a fellowshop exam next year in 2016.

As for the future, I have some dreams and visions. I would like to continue as a clinical academic, teaching medical students and junior doctors. The vision I have is to help address many challenges in health care training, by fostering better “systems of training and education”. Perhaps one way this could be done is through research that also takes into account the important human factors of communcation and compassion, but who knows – tomorrow is still a mystery?

(6) Arnold LK, Alomran H, Anantharaman V, Halpern P, Hauswald M, Malmquist P, et al. Knowledge translation in international emergency medical care. Acad Emerg Med. 2007 Nov;14(11):1047-51.

(8) Lang ES, Wyer PC, Haynes RB. Knowledge translation: closing the evidence- to-practice gap. Ann Emerg Med. 2007 Mar;49(3):355-63.

The Golden Day – PhD submission

Oh the joy of finally submitting the bound, accepted thesis. Thank you! ‪#‎love‬ ‪#‎gratitude‬ ‪#‎PhD #ANU #perseverance


“Improving the medical management of organophosphorus pesticide poisoning through health services research and training” – Bishan N. Rajapakse, PhD , Australian National University, February 2015.


Organophosphorus (OP) self-poisoning is a major global public health problem resulting in over 200,000 deaths each year with a case fatality of 15-30%. Early medical management consists of effective resuscitation and targeted antidote therapy.

This thesis argued that health services research and rural doctor training could be used to improve the medical management of OP poisoning in a resource limited rural Sri Lankan setting, where the delivery of critical care is limited by a lack of diagnostic tests and resuscitation skills. Research investigating the use of AChE in guiding clinical management, and research that measured the effectiveness of rural resuscitation training, were the two streams of research that were the founding pillars of the thesis. These two elements were linked together through a conceptual framework of knowledge translation, each operating at different points in the continuum of evidence being translated into practice.

An AChE point-of-care test (Test-mate ChE) was demonstrated to provide accurate and reliable results in acute OP poisoning when compared with a reference laboratory. A survey based analysis of clinician’s knowledge, attitudes and practices found that most doctors valued the test, but also surprisingly found that doctors who were more experienced with AChE valued the test less. Low proportions valued the test in guidance of acute poisoning management (e.g. to direct oxime therapy and early discharge).

A systematic review highlighted a lack of supporting primary evidence for the use of AChE in relation to oxime use and discharge decisions. Advice on interpretation of AChE and caution about pitfalls in measurement were also lacking. These areas need to be addressed to optimise provision of AChE POC devices.

A train-the-trainer (TTT) model of resuscitation education was effective in improving resuscitation knowledge and skills in rural peripheral hospital doctors, and improvements in most components were sustained for 12 weeks. This demonstrated the effectiveness of using non-specialist doctors to conduct peer-led advanced life support (ALS) training in a low resource peripheral hospital setting, using objective knowledge and skills endpoints according to standardized metrics.

A systematic review of resuscitation of OP poisoning found no texts solely focused on acute initial management. An ‘OP specific’ ALS guideline was proposed based on consistent literature recommendations highlighting the importance of rapid atropinisation (doubling dose regimen) to be delivered simultaneous with immediate airway, breathing and circulation management. Other antidotes such as oximes should not be in the ALS guidelines.

A participatory action research approach was used to address practical problems through close engagement with health services and local training systems. The experience from both streams of research showed that such strategies were integral to the completion of the studies employed in the low resource rural setting. The thesis demonstrated health services research and training could be used to close the evidence-practice gap, and may have a role in the improvement of the medical management of OP poisoning. Future research should investigate clinical endpoints associated with the use of AChE in guiding OP poisoning management, the development of decision rules offering practical guidance in measurement and interpretation of AChE, the evaluation of OP specific ALS guidelines, and the sustainability rural resuscitation training programs.