Light entertainment and Oysters

Dear readers, I have been keeping you waiting for news from South East Asia! Fortunately we were not hit by the tsunami (as some of our more tensed readers might have been supposing). But it was a very busy time none the less... Strange and hilarious things are happening all the time and I can't keep track of all of them; so here are some of the highlights of yesterday and today.

Friday started with a very long visit of all (and I mean all) patients on the ward, both ground and 1ste level. With no assistants it was just dr Rada and me. After the wardround (using hands, drawings, nurses and my very elaborate Khmer vocabulary...), I headed for the OR, tired as a horse from the long week. There I found the two other traumatologists replacing a fractured hip with a prothesis. There were already aided by an instrumenting nurse and I saw the perfect opportunity to eclipse myself towards my cushy hammock. But my plan was foiled by a very generous dr Vuthy who insisted on my helping (in this kind of surgery the fourth player is generally just holding the leg in various positions). No problem I though, just an hour of work and it's breaktime; sleep; food, coffee, ... it was all just a few inches away. But as the operation progressed we had the switch from one prothesis to another and back to first whilst interchanging the heads to find the best fit. One part of the prothesis fell on the ground in this proces and twice I managed to catch another slippery bastard trying to get away. Two hours later and with some pulling and pushing the hip snaps into place and it's closing time. Dr Vuthy leaves this to the assistant and I help him... until the lights suddenly go out. Seconds and then minutes go by leaving us in the most complete dark. I have the genius idea of getting my torch (in my packback). Thrilled with this proof of intelligence I hurry back and shine the brightest Petzl light they could imagine... until after two sutures it fades to a mellow cellphone light barely illuminating anything (damn you cheap belgian supermarket batteries!!). The works proceeds and the final wrapping and bandaging is left to me and the nurses. The final straw came when apparently they ran out of sticky tape just that morning so we had to improvise on how we would go about fixing our construction of sterile swaps. For the "drain" which in belgium is an expensive looking proper drain with a vacuum mechanism bottle, we use a bit of silicon tubing with holes cut in and a surgical glove and for tying it to the tube I use a longitudinal plastic wrapper which had contained the urinary catheter. Under the appreciative eyes of the cambodian staff I start to grasp the Khmer way of improvising.

After that we have a quick lunch and head for the photo-shop to get passport pictures taken for the prolonging of our visas and the tickets to angkor wat. Snap snap and finished... but the processing of the pictures takes several minutes and the printing seems to be a terrible task to perform. Our midday break vanished in smoke. We hurry back to the OR where Katie perform a lumbar puncture (rachy) and I assisted her and dr Rithy in an emergency appendectomy. She can just about to the whole operation! Thank you dr Rithy!

A bite in our favourite local restaurant proves an agreeable experience and we manage to order food and drink! Quite a challenge if nobody speaks anything but Khmer... Early bed for us... but ! As we're getting to the hotel we see our fantastic dr Rithy at the table of the hotel restaurant (owned by him and his wife). He is there in the company of dr Lem so Kong (terrific guy as well), and their wifes. Apparently they were having a company sponsored dinner (in a post-communistic community!) and dr Lem so Kong inquires if we possess a cambodian cellphone number. He urges us to buy one soon because how else will he contact us on a weekend day when.. he's on duty! No temples for us yet....

And so slavishly we get a sim card and head for the hospital at 10.00 AM were we are informed that an appendix is just springing... to meet us. So OR scrubs it is and not feeling too well today (quite some enteric infection since yesterday) I'm not looking forward to it! But then comes a well humored dr Lem So Kong and when we are ready to start operating he introduces three white-clad cambodians girls to stand with their backs to the wall and observe. Midwifes in training he explains! S'ray Saat... The three beautiful girls he translates. The atmosphere is well set for the day. I'm the first assistant today and los geht's. Dr Lem so Kong explains that the pus-like fluid in the abdomen is the result of good and bad soldiers fighting over the appendix. He adds that the good soldiers 'cambodian soldiers' are fighting the bad ' thai ' soldiers. I don't dare to laugh but as he does; we do too! He explains that sometimes a metaphore is the best way to explain something. Searching for an example he turns to Katie and says "when you want to say I love you" and you can't, you say "I am a bee... and you are the flower". General hilarity guaranteed. Then disaster strikes and an instrument falls to the ground; no biggy but superstition states that this will surely mean alot of work to come today! I'm allowed to finish closing for him and he stands by to observe the job being done. He instructs us to insert a urinary catheter but then changes his mind and asks us to assist one of the midwifes (who has never done it). She get's ready to do it under our guidance and halfway through dr Lem So Kong bursts out laughing and says "she has never held a penis in her hands before". We can barely keep it together as the mood is really up today. Afterwards I feel really cold and tired and quite feverish . Dr Lem so Kong had a resembling experience after eating some "delicious oysters" and as he puts it "they made me love the toilet". Howls of laughter... So we retire to a quiet location to have a rest, drink and ... some blogtime!

This afternoon has already an orchiectomy scheduled (that means amputation of the testicle) ... so we're not free as yet! And rumors of beer and dancing we're already in the air ( to celebrate the happy duty day)... so ... very curious about that as well...

Bye bye for now!

L

PS: katie has promised to blog and post pictures in the very near future... ;-)

Nurses on my ward

One of the corridors of the ward, surplus patients are put in the hall until one of the beds is freed up

Our trusty companions the OR nurses Mr Diamond (Pich) on the left and Mr Clean (?) on the right

Friday afternoon staff meeting with the speaker Dr Rada and with regular intervals Dr Rithy
 (subject shoulder dislocation)

Katie doing a spinal lumbar puncture. The patient has had traditional hot ventouse treatment. Unsuccessful apparently.

Cute kid!

Pre-Appendectomy with Katie on the right and the S'ray Saat on the left.