Sunday, November 2, 2014
Wednesday, October 29, 2014
Helsinki, Cambridge, Manchester, London
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| Salmon soup and coffee. It was -2 after all. |
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| "Modern art" = Pink urinating man |
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| This Tea joint was owned by Mr Scruff!* |
Monday, October 27, 2014
Thursday, October 2, 2014
A retrospective entry that failed to upload
*I wrote this entry several weeks ago on my phone, I lost internet before I could upload it. Here it is, no corrections made. The last few paragraphs were lost - but that's how it goes some times.*
So I've been in Africa for the last four weeks. Its been great. A really good time of growth as a doctor, but also stepping out in faith as well.
So far it has been eyeopening.
I guess I'll write about my experience last night as its probably one I'll want to remember.
I got called to assist on theater. A few people turned up from another hospital. Three needed laparotomies. The first, a kid had a typhoid perforation. A belly full of stool and a hole in the bowel. The surgeon stitched it all together and I helped.
It was about 6:30pm by then. They then brought the next person to theater. A chap my age. 24h of acute abdominal pain. Very unwell. He was shocky with hct in the fifties. He had several litres of fluid on the ward. But as I quickly gave him some encouragement in the hallway outside theater, he was writhing in pain.
He looked sick. Blood was coming out of his ng tube, and not much urine in the Foley. As usual here we prayed with the patient before they go to sleep. I held on to his hand as he was freaking out. He calmed and was then induced with ketamine.
Things sadly went wrong after that. The operation started but his bp dropped. The ancient equipment wasn't getting a good pulse. The trace wasn't being compliant. Fortunately a visiting anesthetist had arrived today. We called her to come, but by the time she would get in to theatre we would be pumping up and down on his chest.
I was asked to listen to his chest, the nurse anesthetist couldn't hear his heart. I listened but could only hear the ventilator. The carotid pulse was absent. I asked the surgeon, now elbow deep in blackened intestines if she could feel any pulsing. She could not. She jumped on the chest, and I would follow as she tired. This was my first time doing compressions on a real person. It was terrifying and exciting.
After a minute the anesthetist arrived. She took control of the code. But after 15 minutes the surgeon said she would talk to the family who were waiting outside on the verandah. Meanwhile me and the nurse continued compressions. The anesthetist giving us feedback on how were doing. Turns out that Flinders has actually taught me good technique.
The surgeon came back having talked and prayed with the family. We were all in agreement that we could stop now. Even if we got him back the ischaemic bowel would be unsurvivable.
He had been given adrenaline, amiodarone, calcium and bicarb with no effect. We stopped. And of course, he went from asystole, in to vt. We all watched the monitor. Suddenly it was a shockable rhythm. We debated whether or not to shock it, the defib was ancient and unused in years. We left it. More adrenaline and more amiodarone. He went in to sinus. It was crazy. He'd come back from the dead.
They finished the operation. And I wish I could tell you it ended well. But there aren't ventilators here. He was breathing spontaneously when we rushed him from the OR to the ward. But died during the night. His family surrounding home as he passed. It's important here that people don't die on the table, as it scares people away from the hospital. If they die on the ward its considered somehow more natural.
I'm staying a hundred meters from the hospital. But woke up at 2 am to the sound of wailing being carried on the wind.
So I've been in Africa for the last four weeks. Its been great. A really good time of growth as a doctor, but also stepping out in faith as well.
So far it has been eyeopening.
I guess I'll write about my experience last night as its probably one I'll want to remember.
I got called to assist on theater. A few people turned up from another hospital. Three needed laparotomies. The first, a kid had a typhoid perforation. A belly full of stool and a hole in the bowel. The surgeon stitched it all together and I helped.
It was about 6:30pm by then. They then brought the next person to theater. A chap my age. 24h of acute abdominal pain. Very unwell. He was shocky with hct in the fifties. He had several litres of fluid on the ward. But as I quickly gave him some encouragement in the hallway outside theater, he was writhing in pain.
He looked sick. Blood was coming out of his ng tube, and not much urine in the Foley. As usual here we prayed with the patient before they go to sleep. I held on to his hand as he was freaking out. He calmed and was then induced with ketamine.
Things sadly went wrong after that. The operation started but his bp dropped. The ancient equipment wasn't getting a good pulse. The trace wasn't being compliant. Fortunately a visiting anesthetist had arrived today. We called her to come, but by the time she would get in to theatre we would be pumping up and down on his chest.
I was asked to listen to his chest, the nurse anesthetist couldn't hear his heart. I listened but could only hear the ventilator. The carotid pulse was absent. I asked the surgeon, now elbow deep in blackened intestines if she could feel any pulsing. She could not. She jumped on the chest, and I would follow as she tired. This was my first time doing compressions on a real person. It was terrifying and exciting.
After a minute the anesthetist arrived. She took control of the code. But after 15 minutes the surgeon said she would talk to the family who were waiting outside on the verandah. Meanwhile me and the nurse continued compressions. The anesthetist giving us feedback on how were doing. Turns out that Flinders has actually taught me good technique.
The surgeon came back having talked and prayed with the family. We were all in agreement that we could stop now. Even if we got him back the ischaemic bowel would be unsurvivable.
He had been given adrenaline, amiodarone, calcium and bicarb with no effect. We stopped. And of course, he went from asystole, in to vt. We all watched the monitor. Suddenly it was a shockable rhythm. We debated whether or not to shock it, the defib was ancient and unused in years. We left it. More adrenaline and more amiodarone. He went in to sinus. It was crazy. He'd come back from the dead.
They finished the operation. And I wish I could tell you it ended well. But there aren't ventilators here. He was breathing spontaneously when we rushed him from the OR to the ward. But died during the night. His family surrounding home as he passed. It's important here that people don't die on the table, as it scares people away from the hospital. If they die on the ward its considered somehow more natural.
I'm staying a hundred meters from the hospital. But woke up at 2 am to the sound of wailing being carried on the wind.
Update - no ebola yet
So i've been in Africa for a little while now. I'll try blog it all in retrospect later. Suffice to say it has been amazing.
Presently mooching in Zanzibar, contemplating the indirect route home.
I'll be back.
Presently mooching in Zanzibar, contemplating the indirect route home.
I'll be back.
Tuesday, July 22, 2014
And now for something completely different
War is ridiculous. Don't get me wrong, it's pretty absurd. But war is very inventive. Can you believe we live in an age where you can fire a rocket to shoot down nother mans rocket? I have friends in Isreal, so I do genuinely worry about what conflict in the middle east means for the lives of the people that live there.
So with that preamble, have you seen the videos of the iron dome in action? There is this bizarre interplay of war and normal life.
It's crazy to think you can be sitting at a wedding, listening to Norah Jones while war rages on around you.
So with that preamble, have you seen the videos of the iron dome in action? There is this bizarre interplay of war and normal life.
It's crazy to think you can be sitting at a wedding, listening to Norah Jones while war rages on around you.
I hate people watching me unwrap gifts.
One of the great things about being in a new town is the ability to go visit some new churches. It's a realy exciting opportunity to see how others do that thing we call we worship. So visiting some of the local churches has been good.
This weekends expedition left me a little... I'm not sure what it left me, but I left unsettled and pondering. Essentially the whole service was fine, until the last segment when the pastor encouraged everyone to pray and start speaking in tongues. The whole room broke out in to a steady rumble. I couldn't pick out the sounds of any individual. Just many things that sounded like words but weren't drifted over me.
And I just stood there. Hand on face in a half contemplative half stunned expression. As you might be able to tell, I come from a fairly conservative background where the gift of speaking in tongues is not really something I've seen all that much.
Now that was all quite interesting, but then the appeal rang out, that if anyone who had never spoken in tongues and wanted to, this was the time. Just ask God for the gift. Pray for it now and join the rest of us.
And there I stood, hand still glued to face, feeling somewhat immobilised. I couldn't decide whether I disagreed or was being challenged. Or both.
Now my understanding of spirtual gifts has always been that these are special things. Not everyone can collect the whole set and that they are distributed out so that the individual can use them for the benefit of others and themselves in an appropriate way. It was all very confusing. But above all I try not to put limits on what God can do, even if I might be the world's most skeptical man.
Fortunately I was put on to 1 Corinthians 14.
"18 I thank God that I speak in tongues more than all of you. But in the church I would rather speak five intelligible words to instruct others than ten thousand words in a tongue.
20 Brothers and sisters, stop thinking like children. In regard to evil be infants, but in your thinking be adults. In the Law it is written:
22 Tongues, then, are a sign, not for believers but for unbelievers; prophecy, however, is not for unbelievers but for believers. So
if the whole church comes together and everyone speaks in tongues, and
inquirers or unbelievers come in, will they not say that you are out of
your mind? 24 But
if an unbeliever or an inquirer comes in while everyone is prophesying,
they are convicted of sin and are brought under judgment by all, 25 as the secrets of their hearts are laid bare. So they will fall down and worship God, exclaiming, “God is really among you!”"
I guess this blog post really reflects an immaturity in my understanding of the role of speaking in tongues, but you know what they say:
"adamayd amday admays airthy gaboop."
This weekends expedition left me a little... I'm not sure what it left me, but I left unsettled and pondering. Essentially the whole service was fine, until the last segment when the pastor encouraged everyone to pray and start speaking in tongues. The whole room broke out in to a steady rumble. I couldn't pick out the sounds of any individual. Just many things that sounded like words but weren't drifted over me.
And I just stood there. Hand on face in a half contemplative half stunned expression. As you might be able to tell, I come from a fairly conservative background where the gift of speaking in tongues is not really something I've seen all that much.
Now that was all quite interesting, but then the appeal rang out, that if anyone who had never spoken in tongues and wanted to, this was the time. Just ask God for the gift. Pray for it now and join the rest of us.
And there I stood, hand still glued to face, feeling somewhat immobilised. I couldn't decide whether I disagreed or was being challenged. Or both.
Now my understanding of spirtual gifts has always been that these are special things. Not everyone can collect the whole set and that they are distributed out so that the individual can use them for the benefit of others and themselves in an appropriate way. It was all very confusing. But above all I try not to put limits on what God can do, even if I might be the world's most skeptical man.
Fortunately I was put on to 1 Corinthians 14.
"18 I thank God that I speak in tongues more than all of you. But in the church I would rather speak five intelligible words to instruct others than ten thousand words in a tongue.
20 Brothers and sisters, stop thinking like children. In regard to evil be infants, but in your thinking be adults. In the Law it is written:
“With other tongues
and through the lips of foreigners
I will speak to this people,
but even then they will not listen to me,
says the Lord.”[e]
and through the lips of foreigners
I will speak to this people,
but even then they will not listen to me,
says the Lord.”[e]
I guess this blog post really reflects an immaturity in my understanding of the role of speaking in tongues, but you know what they say:
"adamayd amday admays airthy gaboop."
Tuesday, July 15, 2014
They spell ID with an F here
To celebrate my second week of infectious diseases, I had to do a case presentation. So I summarised the case of a person who had a ? Fungal brain abscess. They had been getting better after surgery, and then went backward... but then got better... bet then looked like they were about to go backward because the numbers were sliding in the wrong direction but seemed okay.
The presentation went okay and everyone discussed the case with great vigour. But I got destroyed by a leading expert in infectious diseases because I had mispelled the name of a rare bacteria (I copied correctly from the neurosurgeons notes I swear!).
The ID people were concerned about the patient, but the surgeons less so given the potential risks of doing another operation. Now a week later, I saw the patient back in the intensive care unit today, with the doctors still no closer to an answer on what was going on. I guess that's just the way it is some times.
It's kind of exciting though. People are listening to things I say some times now. So I feel the pressure to actually make sure it's correct because... Consequences.
In other exciting news, I got offered an internship at my current hospital for next year. Pretty happy! But at the same time I await the news for my dearest colleagues who are yet to hear or have an offer. I'm hanging out on their behalf.
More to come...
The presentation went okay and everyone discussed the case with great vigour. But I got destroyed by a leading expert in infectious diseases because I had mispelled the name of a rare bacteria (I copied correctly from the neurosurgeons notes I swear!).
The ID people were concerned about the patient, but the surgeons less so given the potential risks of doing another operation. Now a week later, I saw the patient back in the intensive care unit today, with the doctors still no closer to an answer on what was going on. I guess that's just the way it is some times.
It's kind of exciting though. People are listening to things I say some times now. So I feel the pressure to actually make sure it's correct because... Consequences.
In other exciting news, I got offered an internship at my current hospital for next year. Pretty happy! But at the same time I await the news for my dearest colleagues who are yet to hear or have an offer. I'm hanging out on their behalf.
Wednesday, July 2, 2014
El queso grande
So I've been back in the Territory for ten days. Once again, I'm reminded how stupidly crazy this place is. They have a whole day where you can buy and launch as many firweorks as you want. It was just non-stop explosions from 4pm till midnight. I'm not even joking. It was the kind of evening that make's living in Palestine look delightful. The news report credited Territorians for the use of their common sense this year - only 13 people had to go to hospital, down from 35 last year.
Speaking of absurdities. One thing that has really surprised me is the number of people coming from detention centers to the various clinics. Also the number of prisoners that get dragged through the hopsital. I don't think I've seen any prisoners or detainees in SA. Sadly I'm referring to prisoners and detainees collectively because they both come in with two guards attached to them. It's really surprising. I always get a slightly weird feeling when I see the two Serco dudes sitting either side of the patient in the waiting room.
"It's a complex issue." - Well if that isn't just the catch-cry of the territory.
On another note, I'm on infectious diseases now. It's amazingly fun. It's definitely moving up the list of things I could see myself doing in the future. Yeah!
I was sitting in clinic yesterday though, and the registrar suddenly says
"Hey you didn't say your Dad was [ A big cheese in this field of medicine], I'm about to call him." So despite being several thousand kilometres away, in another part of the country, people are still talking about you old man! So I sat quietly and I vicariously listened to Dad talking to another doctor about Syphillis.
Hilarious.
Missing you all in Radelaide!
Speaking of absurdities. One thing that has really surprised me is the number of people coming from detention centers to the various clinics. Also the number of prisoners that get dragged through the hopsital. I don't think I've seen any prisoners or detainees in SA. Sadly I'm referring to prisoners and detainees collectively because they both come in with two guards attached to them. It's really surprising. I always get a slightly weird feeling when I see the two Serco dudes sitting either side of the patient in the waiting room.
"It's a complex issue." - Well if that isn't just the catch-cry of the territory.
On another note, I'm on infectious diseases now. It's amazingly fun. It's definitely moving up the list of things I could see myself doing in the future. Yeah!
I was sitting in clinic yesterday though, and the registrar suddenly says
"Hey you didn't say your Dad was [ A big cheese in this field of medicine], I'm about to call him." So despite being several thousand kilometres away, in another part of the country, people are still talking about you old man! So I sat quietly and I vicariously listened to Dad talking to another doctor about Syphillis.
Hilarious.
Missing you all in Radelaide!
Sunday, June 22, 2014
My second second home
Well back to Darwin this afternoon. Six weeks of infectious diseases. It will be strange to use a stethoscope again, yet alone jab someone with a needle.
Psychiatry concluded nicely. I enjoyed my time there. the team was nice and the patients interesting to say the least. The only downside to psychiatry is that the discharge summaries are really long and verbose. Well, maybe that's not the worst thing in the world?
And on that note I'm sure blogging will resume again shortly. I'll be back in a strange land and on my lonesome again!
Bye bye Radelaide!
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| I wonder if I will know anybody on this plane trip? |
Psychiatry concluded nicely. I enjoyed my time there. the team was nice and the patients interesting to say the least. The only downside to psychiatry is that the discharge summaries are really long and verbose. Well, maybe that's not the worst thing in the world?
And on that note I'm sure blogging will resume again shortly. I'll be back in a strange land and on my lonesome again!
Bye bye Radelaide!
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| Of all the mini-mentals I've done this year. This was my favourite free-text. |
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