Helsinki, Cambridge, Manchester, London

Salmon soup and coffee. It was -2 after all.

"Modern art" = Pink urinating man

This Tea joint was owned by Mr Scruff!*

Proof that I had a holiday. More to come.

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.

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.