South East Asia
Cambodia, Vietnam, Laos, Northern Thailand
Act I / Broken Thermometers
Someone gestures there’s only a few more patients until we wrap up for the day, and I’m stumbling toward the proverbial finish line. The Cambodian air is as wet as it is hot, without a hint of breeze to compensate, and sweat is dripping down my back. For a half second I pause to appreciate the organised chaos of our makeshift medical clinic in a rural village outside of Kampong Kdei, an hours drive from Siem Reap. Two Australian GPs and myself, three nurses, and a couple of legends working crowd control for the locals waiting to be seen by a doctor, some for the first time in their lives.
Facilitated by ‘Operation Cambodia’ and with the help of some local medical students for interpreting Khmer, we’ve spent the last few days seeing hundreds of delightful villagers who’ve come from the surrounding areas — some with genuine sickness, others just eager to see what all the fuss is about. The vast majority are standard GP consults; old men with arthritis from years of labouring in the fields, old women with reflux from spoonfuls of MSG in each meal, young men with tummy pains relieved by eating (heartbreaking), young women with 7 children complaining of chronic fatigue (equally so), broken up by plenty of undernourished kids with fevers, coughs and manky ears.
All this complicated by broken communication and inherent cultural ignorance, limited by a small team with only some common medications to hand out, isolated by the practically inaccessible and cost prohibitive nature of a hospital referral. A man in rapid atrial fibrillation on the verge of collapse, a woman 34 weeks pregnant with every symptom and sign of pre-eclampsia, a young girl complaining of worsening headaches with red flags screaming something sinister who should really have an MRI. In these cases all I can do is strongly encourage them to go to the hospital in the nearest town and hope they find a way before things deteriorate.
It’s been our longest day yet, and the emotional burden of my frustration with the perceived sheer helplessness of it all is weighing ever heavy — but with a deep breath I lift my head once more to welcome a new patient…only to see a family of 6 coming toward my table. A sweet but exhausted mother, not yet thirty, carries a severely physically and mentally disabled boy in her arms — 15 years old but no bigger than his sister who is 6. Her four other (adorably cute) children follow in silence to gather around me.
‘Sous-dey. What’s the problem today?’
‘His seizures are getting worse’ my medical student interprets. ‘She’s worried they’re happening more often. He’s been very sick lately. She doesn’t know what to do’. Some questions reveal he was born with what sounds like congenital hydrocephalus, excess fluid in the brain from birth, and I imagine several other genetic issues that I don’t pursue. Despite surgery at birth, it’s still a miracle he’s made 15, his family only able to afford a visit to the Paediatrician in Siem Reap every other year. He’s prone to infrequent seizures, but for several days they have been occurring every few hours, lasting longer and causing him much more distress. I quietly wonder how this boy is still alive.
He’s got a fever, red eardrums and some pus on his tonsils. Not surprisingly so do some of his siblings. I explain to his mum the likely link between his condition, his new infection, subsequent fevers and the increase in his seizures, and stress the importance of monitoring for and promptly responding to similar deterioration in the future. I delicately say what it seems she already knows…one day he might have a seizure so severe it kills him if he doesn’t get immediate help. I start some antibiotics for the infection and something to reduce the height of his fevers while it resolves.
Through the entire examination the boy smiles and giggles, with eyes wide and bright — filled with childlike joy. I hold his hand and earnestly look his mother in the eye, pleading with her — ‘You are doing a great job. You are a wonderful mother’. The interpreter repeats but I swear from her eyes that she understands, and I desperately hope she believes me, even a little bit. There’s a lump in my throat as the woman thanks me and turns to leave the clinic, her son cradled in her arms and her beautiful family in tow. I take a moment, have a breath, lift my head and prepare for the next patient who’s already hobbling over.
‘Sous-dey. What’s the problem today?’




Act II // What Happens In Asia…
Issac Newton: ‘What goes up must come down’.
Robert A. Murphy: ‘Anything that can go wrong, will go wrong’.
Michael Scott: ‘I’m not superstitious…but I am a little stitious.’
All great men at the forefront of scientific discovery, and after finding myself unwittingly caught in a seismic battle between gravity, improbability and incredibly poor fortune in Southeast Asia I can personally attest to the validity of each of their observations. I swear I took my shoes off in all the temples.
With the beauty of hindsight, I admit sharing a private island in Vietnam’s Halong Bay for the weekend with 80 other rowdy backpackers was never going to end well. After a long day kayaking and wakeboarding through magnificent and endless limestone cliffs, the night is escalating appropriately.


Before midnight I take a brief interlude from tearing up the dance floor to soak in the beauty of the evening, an ocean of stars creating an ominous silhouette of the cascading mountains around us. I’m well hydrated and feeling fantastic. As I wander down the beach however I’m confronted by a scene belonging in a post apocalyptic film — left and right people are vomiting violently on the sand, clutching their bellies and beelining to the nearest bathroom. Hysteria sets in and before you can say ‘colossal food poisoning from lunch on the booze cruise’, the manager had 27 sorry punters evacuated to the hospital an hours boat ride away — apparently multiple cases of acute dysentery on an island without electrolytes and limited drinking water is bad for business.
Fortunately for myself and the 50 others who serendipitously avoided the offending dish, we were left to carry on the good times in blissful oblivion. The night gradually winds down in the early hours of Sunday morning, and Coldplay’s back catalogue serenades me from afar as I swim (allegedly naked) out to sea, surrounded by millions of photoplankton and marveling at the clearest night sky I’ve seen in months. It’s a perfect moment…Until I’m stung by a jellyfish dangerously close to the no sting zone. I retreat to bed in excellent spirits, albeit nursing a rather sore inner thigh. The mayhem is just beginning.
I’m granted a few hours of dreamless sleep before the sun streams into our bungalow, announcing another day, and alas another malady. There’s hushed voices gathering outside, whispering with urgency;
‘He fell from the top bunk, on the second floor?! How is he still alive?’
‘What do you mean he was sleepwalking?’
‘Yeah he’s fine now, he’s just sleeping over behind that rock’.
Well that doesn’t sound promising. I poke my head around said rock and find a young British bloke, dozing with his girlfriend crying by his side. ‘Hey there, my name’s Matt — does he need some help?’
‘We don’t know’ his girlfriend offers helpfully. ‘I woke up to a thud on the sand, and he’d just climbed out of the bed and fell from the second storey. I think he missed the concrete but only just. He sleepwalks back home so he must have done it again, he’s been pretty dopey this morning and heaps tired. He’ll be okay right?’
I’ve got a lot of questions. The first of which is why the heck they elected for the top bunk on the second floor next to the balcony if he’s a known sleepwalker. But I keep that one to myself. We wake him up and he’s pretty out to it but can answer some simple questions — namely that he doesn’t remember a thing, before waking up on the sand. He vomited twice already, has a killer headache and just wants to go back to sleep.
‘I didn’t hit my head, I’m certain’
‘But nobody saw you fall, and you don’t remember a thing? How do you know?’
‘Because I feel fine, I’m just hungover and really sleepy. I’m fine’.
I’m not convinced in the slightest. I try to explain to his girlfriend that if he has in fact had a head injury, even a simple concussion, he’s going to say he’s fine. But in the absence of any witnesses, we can’t possibly rule out something sinister, particularly with his drowsiness, confusion, headache and vomiting. If he deteriorates on an isolated island without any resources, he’s going to be in real trouble. He resists the idea of going to hospital for observation, proving my point, and finally the island manager phones the mainland for the second time in 10 hours and another boat comes to take this dude to hospital.
I have no idea what happened to him, hopefully he sleepwalked into a CT scanner. On the boat ride back to Hanoi that afternoon, I discover that I was premature in celebrating my escape from food poisoning. I spend the next 3 days on V&D struggle street, with fevers, hallucinations — you name it. Plus there’s a coral cut on my foot becoming infected. Good riddance to that island, surely my luck is about to turn.



As it happens the gravity is particularly strong in Asia, and it doesn’t mind striking twice. I finally got off the toilet and made my way to the beautiful Laos, where the break neck speed of coastal Vietnam is replaced by lush mountains, epic waterfalls and countless serene Buddhist temples. I slow down for a couple of nights in Luang Prabang to explore some short day hikes as I work on rehabilitating my hip, before I’m due to head south for Vang Vieng and the capitol Vientienne. It’s 4am when I’m woken by screams from the dorm next door. A drunk girl comes running in looking for the stairwell;
‘Oh my god, Oh my god. My friend just jumped off the roof next door.’
I’m reluctant to admit that my first half asleep thought was ‘I didn’t sign up for this shit’. I rub my sleepy eyes, throw a shirt on and head downstairs so see what’s happened — totally unprepared for the scene that awaits. A girl who must still be a teenager lies motionless in her underwear, sprawled like a dead bird across the concrete of the damp alleyway next to our hostel. Her friends surround her on their knees, terrified, begging her to wake up.
I edge through the panicked crowd of onlookers, kneel at her side, get the friends attention and say, for the second time that week — ‘My name is Matt, I’m a doctor back home. Can I help?’
It’s a flurry of disjointed information, slurred between wet sobs. Her name is Florence. She was drunk, they all were. Nothing else though, they’re sure of it. She climbed out of their third floor window to jump across to the roof of the building next door, danced for a bit, slipped and tumbled off the roof, screaming the whole way down. Then silence. She hasn’t moved since. Someone’s calling an ambulance.
‘Florence, can you hear me. Open your eyes if you can hear me Florence’.
Nothing. I lower my head to her chest and take her hand. She’s breathing. There’s a faint pulse. Someone brings towels and we pack her neck in place, relieving her friends arms that are now smeared with blood.A small but ominous laceration is oozing at the back of her head. There’s grazes and cuts everywhere. Her left shoulder looks a bit deformed.
There’s an awkward moment when I quietly shift from kneeling to sitting by her side. My change in posture speaks volumes, and her friends start to panic. ‘Shouldn’t we do something? She’s still not moving!’
I try to reassure them (and myself) that we’ve done everything for now, and until the ambulance comes as long as she’s breathing that’s a good sign. I’m shitting myself under the surface. She’s been totally unresponsive for 5 minutes now. I’m so used to having a whole emergency department of resources and senior help at my fingertips. And now I’m just sitting here in the dirt, feeling absolutely helpless.
I try to be proactive, and explain to her friends that hopefully she will wake up soon, but if she does it’s likely she’ll be confused, disoriented and possibly combative. If she wants to get up, encourage her to stay still but don’t restrain her. If she can move her neck and body without pain restricting her, that’s a good sign. If we force her down she’ll wrestle against any pain to be free, possibly doing more serious damage. It’s counterintuitive, but not worth it. They say they understand.
Sure enough, after a 10 minute eternity, she moans, shuffles her legs and opens her eyes. My heart skips a beats or three as a wave of relief washes over me. Total pandaemonium ensues as this drunk, bleeding, half naked, confused and incredibly frightened girl tries to stand despite a desperate plea from her friends and the crowd. Her friends clumsily support her arms as she stumbles around, tries to vomit, changes her mind, tries to pee, changes her mind and tries to run away. I’m just thankful she’s moving again.
A Laotian ambulance (a glorified ute) finally arrives, and she’s bundled in with great difficulty. The lights and sirens fade up the street, and it’s silent once more. I walk the three floors back to my dorm, wash the drying blood from my hands and inexplicably fall straight back to sleep.
After breakfast that morning, I’m both relieved and horrified to see Florence sheepishly walk over to my table with her friends, her arm in a sling but otherwise looking okay. It’s painful for everyone to relive what happened, piecing together how she fell, reflecting on a traumatic hospital experience just a few hours earlier, where nobody knew how to work the X-ray and they sure didn’t have a CT. She was discharged a few hours later, still drunk and confused with nothing more than potent pain relief.
I say in no uncertain terms she needs to call her travel insurance and find a hospital where she can be properly assessed. She says she doesn’t want to ruin the last week of her friends holiday. I fail to find a delicate way to suggest that if she dies in her sleep from a slow bleed on her brain that would probably ruin it more. She says she’ll think about it. Frustrated but reminding myself I don’t have any reason to care, I tell her friends what to watch for in terms of deterioration, they thank me, and I never see them again. And thus concludes the scariest moment of my trip thus far.




There’s 762 corners along the breathtaking road between the northern hub of Chiang Mai and the hippie paradise of Pai in northern Thailand. 150km of rolling hills, steep mountain passes and pleasant village towns — renowned as a motorcyclists wonderland. After riding up the coast Vietnam a few weeks ago including the extraordinary Hoi Van Pass, I’m becoming increasingly confident yet remain appropriately cautious, keen to avoid contributing to the horrific statistics of foreign deaths on Thai roads. I met Flora and Ngoc last night, and they’re eager to join me for the adventure. We grab a feed and hit the road after lunch — it doesn’t take long for me to realise these girls aren’t here to fornicate with arachnids, and halfway through our journey we’re making dangerously good time. I’m happy taking up the rear, feeling the cool mountain breeze tearing through my chest, practicing picking a perfect line on some hairpin bends and slowing every now and then to wave at a local family, or to let a kamikaze minivan overtake.


After pausing during a brief sun shower, we’re back on the bikes and spirits are high. Ngoc races ahead, and Flora is just leaving my line of sight as I see her fish tail in some loose gravel, falling under her bike as it skids off the road. It all lasts less than a second but I watch in slow motion as she somehow keeps her head up whilst sliding along the bitumen, stopping just short of following her bike into the ditch.
I pull up behind, race over and am shocked to see her crack a smile. Amazingly, she’s okay. There’s a cut on her elbow deep enough to expose some fat but no tendons or bone. I retrieve her bike with the help of some Thai Park rangers that conveniently drive past, and after a few deeps breaths Flora is bravely back on her bike. When we arrive, we stop by the pharmacy and I give her a shopping list — antiseptic wash, gauze, bactigras (apparently exists in Thailand to my excitement) and bandages. Incidentally this is a list I’ll give to more than a few unlucky buddies as the mountains take victim after victim over the following days— including one ride where 4 out of the 10 of us crashed; one poor bloke twice in one day. I can still see him after his second fall, sitting in shock precariously in the centre of the road lighting up a cigarette, mumbling ‘I’ve had enough of this shit’.
Simply put, Pai was my favorite part of the last month; reading for the first time in weeks, picking up a guitar for the first time in months and going on incredible day trips to waterfalls and isolated villages with the most delightful of new friends. However there’s a part of me that wishes I could have billed Medicare for the wound clinic that took place most afternoons in my dorm room, as a new wave of ‘Thai tattoos’ arrived. The nurses of Orange Emergency would be proud.
And so, after the most unfortunate and accident filled month I say to Newton, Murphy and Scott — thanks for making Southeast Asia unforgettable, one way or another.


Act III // Even If You Win, You’re Still A Rat
Since I left Australia I’ve been fortunate enough to meet hundreds of new people, most of whom I’ll spend a glorious day or night with yet never learn their name. For some an undeniable spark forms, painfully aware that in another world you’d be best friends, parting with a bond disproportionately deep for the time spent together.
Sooner or later the inevitable question arrives, ‘what do you do back home’; especially when they hear how long I’m gone. Usually I say I work in a hospital, and leave it at that. But when I trust someone enough to be honest, it’s not a matter of if but when they will ask a variation of;
‘So why did you take so much time off?
Were you not enjoying it? Was it too stressful?
Do you not want to be a doctor anymore?’
Part of my subconscious tenses up, uncomfortable with the innocent yet gross misrepresentation of one of the hardest decisions I’ve ever made. Rather than fumble through a complicated explanation which I’m still yet to reconcile, I tell them this story. And every time I do, I’m convinced once again that I made the right choice.
A few weeks into the last term of my residency, it was a pretty typical shift in the emergency department. A steady flow of interesting patients, feeling confident and comfortable with my growing skill set after a couple of years finding my feet. I’m seeing a burly bloke in his forties, a labourer who’s been feeling rotten for a couple of weeks, unable to shake a cough and getting short of breath at work. He looks terrible considering he’s a relatively young and fit guy. Before I examine him I ask about his home life, not expecting anything groundbreaking, just going through the motions.
Fleeting as if commenting on the weather, he tells me his wife is dying, and he’s struggled for 6 months as the primary carer for her, a 10 year old son with cerebral palsy and their two other teenage kids. He still works full time to pay the bills, and he’s worried he’ll lose his job if he misses any more days sick. ‘I only came to hospital because my missus told me if I don’t look after myself, I can’t look after her’, he says with a wry smile hiding the quiver in his voice.I tell him those sound like wise words, and start my examination.
Part way through he stops responding to my instructions, and collapses in my arms on the edge of his chair. For a half minute his eyes roll back as he mutters incoherently, creating a scene in the less than private treatment room. Before I can get some help to move him to a bed, he slowly returns to the room, dazed and genuinely perplexed about what just happened. I admit he gave me a fright, but remind him he’s in the right place and things are going to be okay. He hears me and nods but his eyes are blank, lifeless — as if they’ve endured enough for one lifetime.
Later an X-ray confirms a pneumonia which he has ignored for weeks, literally pushing himself to collapse trying to stay strong for his family. There was no denying that he was burnt out; and as that warm November afternoon soon revealed — so was I.
The shift goes on, and whilst I’m distracted by other patients I remain somewhat on edge, shaken by this man and his story. I lift my head from writing some notes and catch him weeping silently and alone, staring emptily into oblivion. A tired ghost in an ailing body finally permitted to feel; breaking point met without a whimper of despair, just the quiet sigh of a broken man embracing welcome defeat.
At handover that evening I’m recounting his presentation to the team when I glance over to his bed to see a solemnly devoted family surrounding him; a son looking up in adoration from his wheelchair, a wife visibly upset by seeing her greatest support so weak. A colleague who’s unaware of the context abruptly brings my mind back; ‘He’s a fit young bloke, can’t we treat him as an outpatient?’ It’s a fair question. On face value this is a very straightforward case.
‘This man can’t go home’, I say with defiant conviction, but can’t bring myself to explain why. All I offer with a lump in my throat in front of 8 of my colleagues, most of them senior, is — ‘I just feel like I’ve failed him.’ I don’t even know what I mean, but those words carry the weight of a truth I can no longer ignore.
Everyone is beautifully supportive, reassuring me that I’ve done all the right things, and of course he should be admitted given the perpetuating nature of his social situation. I appreciate the sentiment but that’s not why I’m upset. I know I didn’t fail at my job, it goes far deeper than that.
I was caught off guard, looking through this mans defeated eyes to a weary and weathered soul brought an excruciating awareness of the gradual yet powerful shift in my mindset from enjoyment to survival at work. The pleasure and excitement that medicine brought me for the first 18 months had packed its bags and left unannounced in the dead of night, slowly replaced by a hollow and passionless spirit just going through the motions. I hadn’t failed this man medically, I failed him because my heart was nowhere to be found. My brain and my body were still turning up each day, but I checked out emotionally months ago. And since the job kept getting done, everyone was blissfully ignorant including myself; but without radical change things were only going to get worse.
When handover finishes I take a walk outside and for the first time since it all began I cry at work, just enough to scare the hell out of me. I take a deep breath and return to finish my notes and say goodbye for the day. I cry the whole drive home. The tears are getting heavy and I’m starting to panic. It’s already been a stressful week for my housemates so I sit in my car long enough for the worst of it to pass, before slipping through the back door and into my room. The floodgates open and I wrestle myself in my bed, unable to make sense of why this is happening, just desperate for it to end. I haven’t felt like this in 6 months. I hate it more than anything.
Knowing something’s up, my housemate knocks and asks through the door;
‘Everything alright buddy?’
‘Not really man, but I will be, I just need to be alone for a bit’.
‘Alright, I’m just heading to the pool, I’ll see you in an hour or so yeah? Hang in there dude.’
He doesn’t know this but I pause at this point whenever I share my story, to illustrate just how simple it can be to show love to someone having a hard time. Reaching out a hand but following their lead, offering yourself if and when they’re ready, then getting on with your life. By the time he gets home I’m feeling alright again, I tell him it’s been a hard day but I’m going to be okay. He trusts me enough to leave it there. He’s a better friend than he’ll ever know.
Once the dust settles, I reflect on what was the most emphatic reminder that I made the right choice stepping back from medicine for a year. At twenty four I had one eye watching my peers, registrars and consultants growing more miserable and burning out in their jobs. The other eye was staring down the barrel of years of specialty training, where the furnace gets hotter, on a conveyor belt you can’t simply jump off when you need some fresh air. I had begun to resent this wonderful gift of being involved in people’s lives at their most vulnerable moments; not because I didn’t love the work but because it was a tangible barrier holding me back from everything else that brought me joy. And that’s a sacrifice I’m too young to make.
The glorious irony was that as soon as I made the decision to not apply for any new jobs and essentially become unemployed, I started to take my heart to work once again. Once I gave myself a promise that this wasn’t forever, I began to love turning up each day. As I counted the days to the end of my residency I started to feel the strongest appreciation and thankfulness for the incredible job I’ve worked so hard towards.
And while I’ve been away, I’m thrilled to say that a (rather large) part of me misses medicine. I miss those ugly green scrubs. I miss making questionable jokes with my colleagues to cope with some extraordinary and heartbreaking situations. I miss night shifts in ED watching top gun when things are qu*et, pausing to check on my little old ladies blood results. I miss coming home overwhelmed and exhausted to sit on the back porch and debrief over wine with my best friends.
All circles presuppose, and I can finally answer the question I’ve been asked hundreds of times. Why am I taking a break? Because my patients deserve more than a doctor who left his heart at home. Because I care too much about my future in medicine to become embittered towards it before the real challenges even begin. Because I have no right to tell a forty year old bloke to care for himself if I’m too stubborn to do the same.
This is a marathon, not a sprint.
And I am still running.
