Shit Happens!

On my list of top 5 most dreaded bedside procedure : peritoneal catheter insertion. I think a lot is left to chance when, despite all the precautions we take, some mesenteric vessel or bowel might be sitting right where you intend to stab with a trocar with "gentle force", but force nonetheless, waiting to be perforated. Yes, it's a blind procedure, and I hate being in the "dark"! Is there no better way? Induction of a false ascites isn't necessarily trauma-proof either. I recall an incident sometime last year when my house officer informed me that, on withdrawing the 16G cannula after infusing adequate amounts of fluid into the peritoneal cavity, she had noticed the tip to be faecal-soiled. True enough, after staring at it for a good minute, I finally decided it was faecal material after all. I complimented my HO for her keen eye (it was a tiny speck!) and good sense not to have proceeded with the procedure, but informing me instead. In a place where someone is always to blame for something bad that happens, I told myself that night that I would stand up for this girl if anyone were to start finger-pointing. She had performed the procedure correctly; the patient was unfortunately a victim of a recognized complication of peritoneal dialysis. A former consultant of mine in Kuching once asked me, "So (my name), how many of the stab PDs you did that were complicated by bowel perforation/vascular injury?". Then, having been in service for 3 years, and having performed quite a number of such a procedure, I said none, feeling rather pleased with myself for the clean sheet. He said, "Then you haven't done enough!" and went on with his collection of horror stories associated with PD gone awry during his younger days. No, he's not condoning this practice of unwittingly rupturing guts and tearing vessels, but simply to state a point - even when you have taken all precautions, shit (pardon the pun) sometimes happens. If it hasn't happened to you yet, you're either very fortunate or not doing enough PDs. Since then I have caused 1 case of jejunal perforation; my patient however survived the laparotomy and went home well, if only with an unsightly abdominal scar. Needless to say, I was upset. With that I guess I had done enough. These days, I'm lucky to be able to delegate this task to my HOs trained to do PD. I look forward to the day when stab PD will no longer be mentioned in standard medical text, except perhaps under the section "A History of Renal Support"!

07.07.07

Have you cast your vote? The competition for the New 7 Wonders of The World is on and you can vote online for your 7 favourite heritage sites (out of a shortlisted 21). At time of writing The Great Wall of China is leading the race...wonder if it has anything to do with China being the most populous nation. Malaysia, a young nation relatively, is not represented but please exercise your right. An event of such monumental scale transcends race, nationality and borders. Be a part of this historic, global event. Every citizen on this planet has a right to vote. I've done my bit - and I can proudly declare to my kids years on that I had a part in selecting our new world wonders. My choice? Why, Angkor Wat, Taj Mahal, Machu Picchu, the Pyramids of Giza, the Great Wall of China, Acropolis and Coliseum, of course! The final 7 will be announced in Lisbon on 7 July 2007.

Beatocello!

Let me present to you Dr Beat Richner and his cello...otherwise known as Beatocello! He sings, plays the cello, cracks a joke or two, and talks passionately about his work in Cambodia. On a recent trip to Siem Reap, I had the opportunity to attend his concert and meet him in person. Dr Richner is a Swiss paediatrician who helped set up several non-profit hospitals in Siem Reap and Phnom Penh offering free medical treatment to sick children
(www.beatocello.com/Assets/richner_history.html). The operating costs of these institutions are funded by donations alone. In between his cello solos, we were shown videos depicting the sad state of healthcare in Cambodia. Picture this : mothers ambubagging their own children for there was no ventilator, children getting infected with HIV-tainted blood as there was no facility for donor blood screening, the still widespread use of chloramphenicol as a first-line drug for the lack of a better but more expensive option. His point is, why is it that standards deemed unacceptable in the developed world still apply to poorer countries? Aren't these children worthy too, simply because they come from a less-privileged background? Well, he is a remarkable man, and the locals speak highly of him. Wished there were more individuals like him around.

Beatocello plays every Saturday at 7.15pm at the Jayavarman VII Hospital auditorium. If you happen to be in Siem Reap, take a break from the temples and go experience Beatocello. It might be life-changing.

Laughter The Best Medicine?

My hospital has recently introduced a weekly program whereby staff from every department put up a show...for the patients! Missed the inaugural concert today, but caught a junior MO lurking around in a deserted part of the hospital after the show ended. Couldn't resist this photo opportunity.

I wonder if the patients mind being hauled to the auditorium for a show they did not ask for. I was asked to sign a "certificate of fitness" for a patient to attend - fit i.e. not on oxygen supplement, not on an intravenous drip, not incontinent, not oozing secretions from any body parts etc. You get the picture.

Anyway, it was a good effort. I mean, bumping into a clown lifted my spirits today! I just shudder to think what my department will come up with when it's our turn to entertain. I can't sing and I can't dance, so I'll probably offer myself as the "official photographer"! Watch this space for more photos.

Dare To Fail

Still on the subject of exams, do you know that I sat for 3 mock exams before going for the real one? Surely this smacks of a certain degree of kiasu-ism, but it's nothing like that. I truly needed all the practice I could get. I wasn't comfortable displaying my clinical skills (or lack of them) in the full view of a disapproving audience. With some years of experience behind me I liked to think that my competence and skills are reasonable. Suddenly you have to sit for possibly the most stressful exam in your adult life (for me, that is) and you find yourself in a position to be judged and criticised. In my mind I could almost hear a senior colleague snigger, "you mean she's going for exams?" while I struggle to pick up the right murmur, determine if there's really a spleen or differentiate coarse crackles from fine ones! So there, the greatest hurdle for me was swallowing my pride - it's all right to look stupid if I can learn from my mistakes. The mocks were essential. The first I paid for. Dato Kew said that if we found it useful we should tell our friends about it! Well, it was useful for me. Watch out for the IMU-PACES prep course this September.

Participants of the 2006 IMU-PACES Preparatory Course

The second took place in my hospital. The third, in Kuching - I got to attend by virtue of having been one of them. Thanks, you guys in the medical department of SGH! And oh, I did not pass a single one, but what's more exciting was that my marks improved with each attempt. I thought that was the perfect run up to the actual event. I was so psyched by then I took to presenting mock findings in front of the mirror, in my suit - and I thought I made a handsome candidate too! Now I look forward to helping to organise a mock exam for the next batch of candidates from my hospital who are going for PACES, simply because I want to do my bit in return.