Maybe we're just too close to see the big picture

I find it hard to believe that this time last year I was getting to experience the life of a medical missionary doctor. I find myself constantly reflecting on the experience. The joy that it was to make a difference in peoples lves, and the incredible pleasure in getting to meet and work with some of the missionary doctors and nurses who are there with a great dedication and servant heart.

One consultant surgeon who I really admired was a great example of this. A young woman with real passion and a phenominal talent. But mostly an inspiring love of God. I was incredibly saddened last night to receive the e mail that she had returned to the States because she had become unwell the last few weeks. And now she has been  diagnosed with breast cancer. And I just can't understand it. Where is the sense in it?

Here is a young woman, actually helping people and make a tangible difference in the world, and doing it in God's name, only to be pulled from the field with metastatic cancer. I have no words, and I feel crushed.

If you're the kind of prayer warrior this world needs, perhaps have a read of her latest update: An excerpt:

"As a surgeon, I have spoken the word “cancer” countless times. To my patients, to their loved ones, in academic discussions with my colleagues, and in hearing the sad news of others. I have learned to speak about cancer without emotion and without fear because, after all, like a broken arm or a bean in the ear, it is a clinical problem that I am working to solve. Even when it involves sharing difficult news with a patient or hearing of the tragic diagnosis of a friend, it does not consume me, and rarely does it change me. This week, however, I have heard and spoken the word “cancer” more times than I can recall. And all of them in regard to me."

And so I'll leave you with this. A sneaky little recording I made of one of the church services I attended. This is a language that only two million or fewer people speak - so I can guarantee you've never heard anything like this before. Except you have.

Visions of Zanzibar

I recently put a new hard drive in to my aging 2010 era macbook. Now when I say recently I mean February. Of course, the fresh computer smell eking out from under the aluminium underbody wasn't the only benefit. It freed my computer of five years worth of files (and those things are heavy!)

Unfortunately I lost all my firefox tabs, because I was too impulsive to back those things up. So a lot of sites I used to frequently visit when I procrastinate just kind of ceased to be visited. Long story short I've not really blagged. Nor read your blags. Crazy I know.

Quick update then. I survived my 11 weeks in ED. And just as importantly I survived my surgical term in vascular surgery - and even managed to enjoy it at times. Now I find myself in gen med - where dreams go to... maybe not die. But my dreams are being palliated aggressively. The part I'm finding the most intimidating at the minute is the cover shifts though. Surgical cover shifts were easy.

Person has no blood? But more blood in! But medical cover shifts are more complex. Everyone has loads of co-morbidites. Mmm. It's okay though on the whole.

So that's it really. Haven't had anything terrible happen to me yet. Nobody has died on me and for some reason I get paid to turn up each day.

How things have changed!

And now for something completely different: Tomorrow is the shortest day of the year. So get ready to say goodbye to your seasonal affective disorder. Summer is coming! *Yeah!*

ABCDE

Well. Medical school finished and tomorrow I start work as a doctor. I'm feeling slightly angsty at present, but I'm sure once I say hello to that first patient it will all be... okayish.

On a serious note, please don't hurt yourself or become ill over the next little while...

Zambia part 1 - holidays bits

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.