Sunday, 15 September 2013

Dream: a riot in East Timor and stroke diagnosis with kava

In this dream, I'm attending a conference on developing world medicine. The venue is in a large swanky hotel in Dili, East Timor - though it appears modern, on closer inspection it's actually somewhat rundown - bits of paint peel and there's light mould growing in the corners.

We are in the conference room, and whilst having a tea break, see on TV that it is the day of the Timorese election. There aren't many people at this conference - 20 at most including a handful of local doctors. We watch the TV together intently, as the votes are counted.

Suddenly the TV coverage switches to the street, where there are people protesting in the street. We decide to go outside to see what is happening for ourselves, but when we get to the lobby of the hotel, we find the heavy doors closed and surrounded by security guards.

I go up to my room and from its window, I can see people rioting in the streets. It looks violent, with the distinct smell of burning tyres and short bursts of gunfire. People lie in pools of blood on every corner, and police tear around with large gas canisters spraying groups of shouting men.

There is an announcement on the PA system for us to re-attend the conference room. When we get there, the man who appears to have won the election (against whom everyone is protesting perhaps?) is standing on the podium. He starts a long speech about how he, as the newly elected president, will bring peace and prosperity to the Timorese people. He is the owner of this swanky hotel and he plans to take western money spent at the hotel, and give it to the poor.

Bullshit, I think. Another dictator in the making.

Suddenly he collapses and lies motionless on the ground. A few of the doctors from the conference and I go up to the stage and check on him - he's breathing with a good volume pulse, but is profoundly unconscious.

We start debating how we should get him to a hospital for a scan of his head, as it looks like he's had a stroke. Two of the doctors start saying he needs a CT angio! no, he needs a MRI. Someone points out that there is no MRI machine in the whole country.

A local doctor comes up with the idea that he has an ancient X-ray machine he was using as a museum exhibit item at the conference, a sort of show-and-tell item. He thought that we could maybe use it to do a contrast study. Another doctor suggests that we could use the local kava, which is apparently extremely radio-opaque. One of the president's bodyguards produces a bottle of the stuff, which is crusted with dirt and looks extremely dodgy.

It is a white liquid as we pour it out and down a funnel into a long metal needle we have inserted into the president's femoral vein. The first doctor snaps the X-rays efficiently, and soon we have a handful of images which develop slowly much like film. When the pictures come out they look amazingly like CT scans and I immediately spot the basilar artery thrombosis.

Look, he has basilar artery thrombosis causing posterior circulation stroke! I say to the crowd. We need to get him to a hospital for embolectomy.

The security guards step in and say that there's no way we can take the president to a hospital. Then I wake up. 

Saturday, 7 September 2013

Hiram: moving out of the nest


We went to pick up Hiram on a sunny Sunday when the Guide Dogs association had their annual open day. Hiram and his brothers & sisters were part of the dog demonstrations where the trainers showed them off for their maximal cuteness value.



Of course we wondered which one of them we would get! Afterwards we headed over to the puppy pen.


And there was one lazy puppy sleeping whilst the others played around him.



Then there were two.



And then there were three.



The fourth to come was particularly pale and we thought this was our one because the trainers told us we had a light coloured one.



One of the six puppies had already gone to their home, so this is all five that were in the pen at the time.



This lazy puppy didn't even wake up for food!!


Time for a drink.



Training to sit.


All along we thought we had the super white one, but I secretly wanted the one that was sleeping the whole time. In the end when we were about to take our puppy home, the trainer came and picked out the sleepy one and he was ours after all! Hiram said goodbye to his brothers and sisters, and came home with us.