It has come to my attention that nothing is really as it seems in Cambodia, so every-time I think I have finally got something sussed karma will throw a curve ball right back at me. Sometimes this can be unbearably frustrating and morale breaking yet other times it is quite simply perfect - in a bitter sweet way.
The monks changing the 5 am plinky plonky music and chanting from a weekly event to a 4 am drum banging session that will be nightly for the next 3 months, culminating in a 14 day festival, all day chanting and music starting at 3 am, is definitely a turn for the worse - I live RIGHT next door to a pagoda.
The ants, extra protein, in my breakfast smoothies are however just a fact of life now, nothing curvy or ball-like about it.
But for example when I had finally accepted that all other road users were basically out to kill me, a moto driver actually stopped & gave way to me today. Generally they prefer to overtake you just as you are clearly turning left. A great example of this was last Friday, I sat waiting on the balcony of the Gecko Cafe for Louise and as I gazed down expectantly at the 'rush hour' traffic of the 'Bang' I noticed a pre-pubescent boy and a woman picking up Lou from a muddy puddle on street 3. The boy had decided to overtake Lou as she turned left (why not?) and had knocked her off her bike with such force that the pocket of her jeans is an imprinted bruise on her arse.
Lou had spent the previous 5 days, working 12 hour days, painting the Paediatric ward at her hospital - URC staff comments on her efforts included "you should have more animals - birds - children like birds Louise, and bears" and "There should be paintings of children playing". She had a particularly infuriating conversation about the khmer alphabet which involved a URC staff member telling her it was his idea to have it painted on the wall and Lou trying to explain to him it was already painted by the sink and then the URC staff saying "Yes that is my idea - you should paint the khmer alphabet on the wall" and so the conversation continued to insanity and beyond.
Katie went to a meeting without her VA last Friday and not only understood the gist of the conversation but spoke to the director afterwards about some of the points in khmer. She was also was expected to give an impromptu speech in khmer. Her feedback was how funny it was that she couldn't survive without her VA and her khmer was not good. When her VA told me he thought Katie wasn't so happy about the meeting, I explained the concept of positive feedback and encouragement and how perhaps in future he could say some nice stuff as well as criticism, but he declared "her khmer is not good but that does not mean that it is bad!". Later that day when Katie came around for tea she was looking rather bemused and puzzled. Her VA had told her that afternoon that "he loved it when she spoke khmer", when I confessed to my little 'chat' with him she looked relieved - positive comments from a Cambodian about speaking in khmer - a curve ball too far.
In work today I was sat on a bench outside the surgical ward talking with Mr S, the head nurse, about the same subject of positive and negative feedback. So it came to pass that I found myself getting the talk I'd given Katie's VA being given straight back to me - what goes around, comes around. Mr S thought I was improving ie less critical (probably because the medical culture shock is abating) and then suggested a team building away day every 6-12 months. Two months ago I would have probably cut in and explained I didn't have money to take the whole ward to the beach. But today I sat listening and then said "I think that is a really good idea, lets see if we can get some funding for that" - I'm taking mine and Mr S's advice and focusing on the positives.
On ITU today a regular attender with heart failure had a cardiac arrest and I calmly watched as an 'attempt' to resuscitate her commenced. No defib or monitor, no emergency trolley, a bag valve mask but no oxygen tubing, no intubation kit, poor cardiac compression with loooooong gaps - no chance of survival. She remained dead and I took my VA and myself for a walk and some reflection time.
I did go back later and not only did the staff all agree that basic and advanced life support training was necessary (they didn't even mention kit for a change, ironically it was me that said they did need more resources) but they also said this week was too busy but perhaps I could teach them next week. This resulted in me having to suggest that maybe this was a case when ward based teaching (what I have been advocating until I'm blue in the face) wasn't the best forum and perhaps it needed a more formal 2 day course (with snacks and per diems). How the mighty have fallen, I'm a heartbeat away from running a 'workshop'.
Then the ward threw me a complete curve ball - ok- says I - as the life support course will take a little time to organise, is there anything I can do for you sooner? I've been asking this question since I got here and the answer is always the same a) silence, or b) money. But this morning Mr So, chief of ward, looked me in the eye and said "well we could do with a session on blood transfusion, indications, what checks to do, what to monitor, what to do after, things like that". I swear I nearly fell off my stool, apart from the fabulous training suggestion I wasn't aware his English was so good.
But the best curve ball this week happened whilst I was getting my paeds fix and reflecting on the worst resuscitation I have ever seen that morning on ITU medicine. I have a few favourites on the paeds ward that I like to visit daily- these include a little boy with dengue who has the best smile, a baby with the worst bowel obstruction I have ever seen whose mother has been very tolerant of all the photos I have taken of him, the apnoeic neonatal sepsis baby who I just like to make sure made it through the night, and then of course there is Dr CP and Dr M who are the all star paediatricians.
This morning however it was a relative that threw me the curve ball. She warmly grabbed my hand and started imploring me to come with her. My VA finally made sense of what she was saying and it turned out that she was the mother of a past ITU medicine patient and she had something to show me. The patient was the young girl who had the moto accident and had been flown to Vietnam with her head injury and ended up with an infected VP shunt. The last time I had seen her she was being sent home to die as a hopeless case. It really upset me at the time as I felt that the patient had been stuck in the middle of a battle of wits between me & Dr L, who had wanted me to intubate her which I had refused to do (its all in an earlier blog). Well it turns out the neighbour who was a midwife had recruited another doctor to treat the patient privately - she had got the antibiotics denied her at the hospital and although by no means well she was miraculously still alive. Some what more miraculously was what I had assumed was a full bladder was in fact a uterus with a 6 month fetus in it! No-one else had picked up on this fact either until she had delivered at 30 weeks gestation at home unexpectedly.
The mother (now grandmother) was full of joy about the new addition to her family, it was such a stunning contrast to the distraught woman I had wordlessly comforted last month. I was able to tell her via my VA how sorry I was about her daughter and how deeply it had effected me. She thanked me and hugged me. Then we all stood around the cot marveling the little dot of her grandson.
While since I'm in the ball park of americanisms I guess thats what they call closure!
The monks changing the 5 am plinky plonky music and chanting from a weekly event to a 4 am drum banging session that will be nightly for the next 3 months, culminating in a 14 day festival, all day chanting and music starting at 3 am, is definitely a turn for the worse - I live RIGHT next door to a pagoda.
The ants, extra protein, in my breakfast smoothies are however just a fact of life now, nothing curvy or ball-like about it.
But for example when I had finally accepted that all other road users were basically out to kill me, a moto driver actually stopped & gave way to me today. Generally they prefer to overtake you just as you are clearly turning left. A great example of this was last Friday, I sat waiting on the balcony of the Gecko Cafe for Louise and as I gazed down expectantly at the 'rush hour' traffic of the 'Bang' I noticed a pre-pubescent boy and a woman picking up Lou from a muddy puddle on street 3. The boy had decided to overtake Lou as she turned left (why not?) and had knocked her off her bike with such force that the pocket of her jeans is an imprinted bruise on her arse.
Lou had spent the previous 5 days, working 12 hour days, painting the Paediatric ward at her hospital - URC staff comments on her efforts included "you should have more animals - birds - children like birds Louise, and bears" and "There should be paintings of children playing". She had a particularly infuriating conversation about the khmer alphabet which involved a URC staff member telling her it was his idea to have it painted on the wall and Lou trying to explain to him it was already painted by the sink and then the URC staff saying "Yes that is my idea - you should paint the khmer alphabet on the wall" and so the conversation continued to insanity and beyond.
Katie went to a meeting without her VA last Friday and not only understood the gist of the conversation but spoke to the director afterwards about some of the points in khmer. She was also was expected to give an impromptu speech in khmer. Her feedback was how funny it was that she couldn't survive without her VA and her khmer was not good. When her VA told me he thought Katie wasn't so happy about the meeting, I explained the concept of positive feedback and encouragement and how perhaps in future he could say some nice stuff as well as criticism, but he declared "her khmer is not good but that does not mean that it is bad!". Later that day when Katie came around for tea she was looking rather bemused and puzzled. Her VA had told her that afternoon that "he loved it when she spoke khmer", when I confessed to my little 'chat' with him she looked relieved - positive comments from a Cambodian about speaking in khmer - a curve ball too far.
In work today I was sat on a bench outside the surgical ward talking with Mr S, the head nurse, about the same subject of positive and negative feedback. So it came to pass that I found myself getting the talk I'd given Katie's VA being given straight back to me - what goes around, comes around. Mr S thought I was improving ie less critical (probably because the medical culture shock is abating) and then suggested a team building away day every 6-12 months. Two months ago I would have probably cut in and explained I didn't have money to take the whole ward to the beach. But today I sat listening and then said "I think that is a really good idea, lets see if we can get some funding for that" - I'm taking mine and Mr S's advice and focusing on the positives.
On ITU today a regular attender with heart failure had a cardiac arrest and I calmly watched as an 'attempt' to resuscitate her commenced. No defib or monitor, no emergency trolley, a bag valve mask but no oxygen tubing, no intubation kit, poor cardiac compression with loooooong gaps - no chance of survival. She remained dead and I took my VA and myself for a walk and some reflection time.
I did go back later and not only did the staff all agree that basic and advanced life support training was necessary (they didn't even mention kit for a change, ironically it was me that said they did need more resources) but they also said this week was too busy but perhaps I could teach them next week. This resulted in me having to suggest that maybe this was a case when ward based teaching (what I have been advocating until I'm blue in the face) wasn't the best forum and perhaps it needed a more formal 2 day course (with snacks and per diems). How the mighty have fallen, I'm a heartbeat away from running a 'workshop'.
Then the ward threw me a complete curve ball - ok- says I - as the life support course will take a little time to organise, is there anything I can do for you sooner? I've been asking this question since I got here and the answer is always the same a) silence, or b) money. But this morning Mr So, chief of ward, looked me in the eye and said "well we could do with a session on blood transfusion, indications, what checks to do, what to monitor, what to do after, things like that". I swear I nearly fell off my stool, apart from the fabulous training suggestion I wasn't aware his English was so good.
But the best curve ball this week happened whilst I was getting my paeds fix and reflecting on the worst resuscitation I have ever seen that morning on ITU medicine. I have a few favourites on the paeds ward that I like to visit daily- these include a little boy with dengue who has the best smile, a baby with the worst bowel obstruction I have ever seen whose mother has been very tolerant of all the photos I have taken of him, the apnoeic neonatal sepsis baby who I just like to make sure made it through the night, and then of course there is Dr CP and Dr M who are the all star paediatricians.
This morning however it was a relative that threw me the curve ball. She warmly grabbed my hand and started imploring me to come with her. My VA finally made sense of what she was saying and it turned out that she was the mother of a past ITU medicine patient and she had something to show me. The patient was the young girl who had the moto accident and had been flown to Vietnam with her head injury and ended up with an infected VP shunt. The last time I had seen her she was being sent home to die as a hopeless case. It really upset me at the time as I felt that the patient had been stuck in the middle of a battle of wits between me & Dr L, who had wanted me to intubate her which I had refused to do (its all in an earlier blog). Well it turns out the neighbour who was a midwife had recruited another doctor to treat the patient privately - she had got the antibiotics denied her at the hospital and although by no means well she was miraculously still alive. Some what more miraculously was what I had assumed was a full bladder was in fact a uterus with a 6 month fetus in it! No-one else had picked up on this fact either until she had delivered at 30 weeks gestation at home unexpectedly.
The mother (now grandmother) was full of joy about the new addition to her family, it was such a stunning contrast to the distraught woman I had wordlessly comforted last month. I was able to tell her via my VA how sorry I was about her daughter and how deeply it had effected me. She thanked me and hugged me. Then we all stood around the cot marveling the little dot of her grandson.
While since I'm in the ball park of americanisms I guess thats what they call closure!
Post script - It seems hideously appropriate that this afternoon when I went to the Paediatric ward and Chan asked where the baby was we were told, "He got a passport to the US". My VA was confused and all the nurses and medical assistants just laughed at him (the all stars are both away at meetings), I didn't understand what they were saying but I know enough about an empty cot and the staffs apparent laissez faire attitude to know that in the UK our euphemism would be "He went to Rose Cottage". I think it says something that in our culture dead people are said to go to a country cottage and here in Cambodia they get their ticket out of here to the states - land of the free! Of course I should have known that it was too good to be true - there are rarely happy endings here. Chan & I left the ward and went to sit on the veranda of the Surgical Ward. We had a long discussion about buddhism and human nature, we watched children playing a game under a shelter whilst the afternoon rains came and after 40 minutes I said "Come on Chan we can't be sad about a dead baby for ever" and we picked ourselves up and carried on but with heavier hearts.
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