Dispatches From The Back of My Mind

The new room has turned into a fought over territory. Starting this weekend I have been engaged in a constant battle against the hordes of ants. Their bites pack a mean punch. I’m wondering if they were the culprits behind my spate of itching bites (they were confined almost entirely to my feet and lower legs). I hope that they are just as susceptible to the DEET repellent as the mosquitoes were. Whatever it is that’s causing the issue, soon it won’t be my problem. Shortly I leave Guyana. There’s an app online which lets you track your plane. As of typing mine is in Honduras.

On Monday a dreadful motorcycle collision comes in. The young woman on the back was in X factor. She is pretty badly hurt. As she is being intubated in the critical bay, a nurse beside me asks our opinion on her ethnicity. Its one of the details to be recorded on the admission forms. By this point it seems pretty irrelevant. She doesn’t make it. Her relatives loudly mourn her. I can hear them from the other end of the department where I am helping to set her ‘boyfriend”s leg. I use the inverted commas because when asked he doesn’t know her name.

Later on we receive some excellent teaching from an local cardiologist and an ER doctor from Vanderbilt on Heart Failure and Disaster Management. During the teaching, the cardiologist refers to the UK as a first world country when discussing the management options post-MI. It is weird to hear someone from a self-professed third world country call us that, like she’s admitting defeat almost. It seems archaeic.

Throughout most of last week I had lunch at House of Flavors. I don’t think I’ll ever be hungry again. It is the same creole food every day and there’s only one smorgasbord option on the menu, but it’s delicious and costs less than 1. Plus I think it has all my five a day and comes with sriracha sauce. No wonder my I’ve restricted my diet. To branch out I try going to some other restaurants. Steppers and Maggies’s (a deli) are ok, but it is more expensive and less good. I’ll have to stick with the best lunch in the world I guess.

On my way back from the market I pass a busy crossroads with all of the drive-thru restaurants and have an unpleasant shock. Two men in seemingly plain clothes walk out of a restaurant carrying pump action shotguns. This is it, I think, everyone here is about to be robbed. I am everyone. I’ve read about the high crime rates in Georgetown but I’d hoped by playing it safe I’d never have to be the victim. I have never before truly experienced the sensation that people describe in books as ‘my heart ran cold’ but that was what it felt like. It was only when they turned away from me that I could see the teeny tiny security logo on the back of their t-shirts. A third was sat in an outside booth with mirror shades and a milkshake. The relief, phew! They need some ID badges or something. The duo got into the back of their armoured car which was parked around the corner. I guess you shouldn’t jump to conclusions.

On the EU result I’ll keep it short but I will say this. I am disappointed. I had hoped to do some travelling and maybe even work abroad after my degree. This will be a barrier to that. In my opinion we were better off in both financially and culturally but I suppose only time will tell. On the morning of the announcement I was revising Spanish. Normally I only spend twenty minutes doing this but on that day I kept it up for three hours.

On Friday night we had another blackout at about 9. The music next door shut off and all of the car alarms sprang to life. They’re on a hair trigger I tell you. A large cockroach surprised me in the shower. It waggled its enormous antennae at me then skittered away when I flicked it with my foot. I still hate mosquitoes more.

At the weekend I watched the Glastonbury coverage with my Sheffield VPN on iPlayer. I got to see Sigur Ros live (on my laptop, I have yet to see them in person), Wolf Alice, Adele and many more as well as being able to catch up with the sets of Foals and Paul Heaton. One year I’ll make it. For now it’s just another way of marking the summer; I know that someone will be watching it at home in the kitchen with the French windows ajar.

I left the guesthouse to buy a pineapple from the market and was caught in the downpour. Most people were laughing. I met a very friendly teacher who asked me how Guyana can improve itself. I didn’t to be rude so I mentioned something about seatbelts which made him laugh. I get my pineapple and take some good photos. Georgetown is one of those cities which is equally beautiful in the rain, if not more so. At least the weather is warm. At home the pineapple is attacked and diced by a cleaver and serves lunch for one over three days. Or two, since some of it goes missing from the fridge.

After doing the Epley manoeuvre for a week, I think my BPPV has gone, a relief. It’s been an odd an unpleasant experience and I wonder what triggered it. At least I’ll never forget it for any OSCE in the future.

Dispatches From The Back of My Mind

Robert Dyas And LGBT Presence In Advertising

Robert Dyas and LGBT Presence in Advertising

Link

Third

On Monday A and E is full for the first time that I’ve seen it. As expected, most of the patients are outliers who haven’t been admitted to the ward. Lots of angry phonecalls are had. Meanwhile, people are still arriving in triage. Where are they supposed to go? Every bed and every chair is full. A doctor from a medical ward comes and complains about the treatment of his patients and starts an argument between himself and another doctor because the nurses prioritise ER patients for care over outliers. Rightly or wrongly, i can’t help but feel that if he really cared, he’d stop wasting time with arguing and get back to admitting and discharging his patients rather than leaving them to ferment in the A and E.
A host of Chinese students crowd in to the already compact ward. They introduce themselves to me then give each other a tour. Some of them are taking pictures and selfies, which isn’t particularly appropriate. I should correct them, but feel too asthenic and don’t.
The Canadians leave on Wednesday morning. They go out to Hibiscus one last time with their friends from Berbice. It will be much quieter without them around. I’m going to have to make my own fun. In addition to a lovely card, they leave behind some pineapple for me, which is much appreciated. Now I am the sole guest in the hostel, hopefully not for long.
All of this leaving and moving on reminds me of home. It stil hasn’t sunk in that when I reutrn, a number of people will have graduated medical school and will be off to other cities and other hospitals. In addition to this, I will have moved into a brand new house for the first time in four years which is also bizarre. There are so many changes and transitions in life at the moment, how am I expected to hold on to all of these people and memories and possessions. It feels necessary that someone or something is going to fall through the cracks with the upkeep.


There is a new medical student from Newcastle, Siobhan. She lives with her cousin who is the British Commissioner here. Lots of canapes and talking to people apparently. She was offered a helicopter by someone who worked for Tate and Lyle. Is that more or less expensive that a medical degree nowadays? Being a quiet Wednesday morning we sit and ask about her experiences.
The last person I see before I leave arrives in handcuffs with his screaming mother. This ought to be interesting. He took the farming chemical Paraquat outside the Court of Appeal in order to take his own life. He is screaming and sweating. He chokes on frothy vomit which is a mixture of pine green and thick gouts of blood. We try to pass a tube through his nose for a lavage but he continually pulls it out. Swallow the tube! His mother yells, but he chews it instead. This type of scenario is not that unusual in Guyana, who can boast the highest suicide rate in the world. The favourite methods and hanging and self-poisoning. If you walk around town you will see adverts and billboards for crisis hotlines to try and lower this dreadful statistic.
When I asked the locals why this was, they told me a confused story concerning Guyana’s culture; close family ties, not wanting to embarrass your family, hanging and paraquat ‘traditions’, a culture of silence and an inability to discuss problems with your family; plus the ease of access to lethal means from within the farming community.
Back to Paraquat overdosing. It’s not an especially pretty way to go, almost makes paracetamol look pleasant. Paraquat is a herbicide named for the para positions of the quaternary nitrogens in its molecule. It has been linked to Parkinson’s Disease and is banned in the EU, so we may see a resurgence in the UK shortly. If you aren’t killed by its altering of your physiology towards acidaemia, the ARDS and rapidly developing pulmonary fibrosis are sure to get you.
In the afternoon I go for a stroll along the sea wall again, coming back through the National Park. Allegedly there are manatees here, though I fail to spot any. Instead I wonder around off the bitumen track. It is very quiet here and with all of the trees it would be easy to forget where I am again. I get back just in time to avoid the rain. I still haven’t bought an umbrella, which during the worst rainy season on record is a ridiculous oversight. Thanks, El Nino.
On Thursday a hard rain falls overnight and leaks through the ceiling. The guesthouse is built to withstand the heat, which means that there are a lot of windows, vents and the like. Rain comes in easy, as do lizards and insects seeking shelter. At the hospital I spend the morning doing sutures, one set of which on another man who has attempted suicide by trying (unsuccessfully) to open up is radial artery. He has a Chelsea smile scar across his cheeks. I have never seen one of those before. I think better than to comment.

Third

Another Letter From Guyana

Monday greets me much like the first man I see when I arrive at the ER; dry retching on the floor. At least he has a bucket. It strikes me as strange that by the end of this, I will have worked more shifts in an Accident and Emergency Unit abroad than I will have done at home. There’s something in that, though I think I had much more to do in the UK. I know more about the systems, could take more reliable histories and was felt more capable. Conversely, the teaching I have received here easily dwarves that which I had at Northern General and I’ve only been here two weeks.

On Tuesday the X-Ray display for the department stops working. It is Friday until it is repaired. I hope we don’t desperately need it. Funnily enough, that’s four days, the length of time I have seen some patients stay here awaiting a bed. They are admitted under a team as an outlier and are seen and managed, in theory by that team. Of course, as with all outliers, they immediately fall to bottom of the list and their care is substandard. Plus, they’re blocking a bed in an emergency ward. Does nobody else think that this is unsustainable?

My cold seems to be getting better. Must be all of the spicy food I’ve been going for recently. Lacytown is mostly my hunting ground this week. Its actually really easy to be veggie: all of the rastas and indians. There are plenty of good options, even several exclusively vegetarian/vegan restaurants. Shame that most of them are only open for lunch. Up until now I’ve been lazy and mostly only eaten Indian/roti dishes.

Speaking of changes, I’ve finally caved in and bought DEET insect repellent. The insect situation was getting desperate and I was pretty foolish not to do it sooner. My feet are a mass of itchy purple blotches. After a week of repellant they are given a chance to heal. I actually rather like the smell, even if I am horribly allergic to it.

A new set of students has started this week. They will be here for four weeks. Jifesh, Shaya and few others working opposite shifts to me. With them I see several memorable cases: MVA bike versus cow. The cow won. Also a ten year old boy who died. He was dead when they brought him in. There was nothing to be done. Afterwards the Canadians ask how my day was but I can’t raise it.

At the weekend I explore a little more around the port and river areas. Some parts of it are very quiet and deserted, not especially safe for a tourist by himself. But the rusted big machines look spectacular. Real urban decay and shipping crates being taken over by the silt from the riverbed and jungle vines and flora. There are odd buildings here not limited to an ice factory and a communal abattoir. A lot of these big devices for moving earth and wood are put onto barges and shipping upriver to the interior to be used in timber production etc. Guyana is a country with a lot of problems, but sometimes is really cool. John Milton wrote about unspoilt Guiana. Sometimes I feel as though I can see it. 

Another Letter From Guyana

The ER Layout

Dr. Bux, the consultant is around for only two half days a week. I have met him in passing only once. There are four main areas after triage: quick resus, bay, fast track and critical. Quick Resus is almost entirely asthma and COPD. There 10 fast track chairs, 3 critical beds, 24 trauma beds and 12 quick resus chairs. Shift patterns are more or less the same.

There’s an on site lab able to run certain tests; blood film fbcs, urine dip and microscopy. These are usually done by the technicians. Anything more complicated is usually private. On site social workers too. The A and E is very well staffed. Possibly the best staffed a and e i’ve been in! One nurse to four patients.

Flies. Flies absolutely everywhere.

If we don’t know what it is, youre getting an x ray and ecg, the guyanese equivalent of one tube two tube purple tube orange tube for every a and e attendee in the UK.

The ER Layout