Day 61: 24/09/12

Today is my final day in Sri Lanka.

I spend the morning finishing my packing and cleaning the apartment. I double check that I have everything and with the heavy rain, I keep a close eye on the flight status. Anne tells me that due to the rain, the driver will come about half an hour earlier. She also tells me that her eldest son, Mevan, is working at the airport close to the time I should arrive so hopefully I will be able to see him and say goodbye.

These two months have come and gone quicker than I could imagine. Some days have been longer than others but overall this has been really wonderful. I’ve met so many great people who I hope to stay in touch with well after I leave here. Anne and her family have been so kind and welcoming, I really have felt at home. I will miss the local eccentricities. The lady with big round glasses that cycles passed me on the way in and yells, “MOARNEENG!” The dogs that follow me down the road until they realise I’m not playing a game. The bus conductors yelling what sounds like, “Crap! Crap! Crap!” The flashing lights around the Buddha pictures on the bus and the dangling flowers. The rotis, the curries, Unawatuna, Three Coins, arrack and Lion ginger beer. Yes, I might even miss Billy.

Thanks very much for all of the interest in my blog over the past two months. The stats speak for themselves and I can’t believe I’ve had so many readers and subscribers; this was originally only meant as a way to keep in touch with home! I expect that I will take a break from blogging for a little while but will make use of this blog in a different way soon enough, so don’t run off just yet.

London Heathrow, see you soon!

Day 60: 23/09/12

One.

The sun rises and I feel like new. Even after all these hours it is still raining outside just as ferociously as when it began. I eat my breakfast, and shower before hauling my suitcase away from its two month home in the storage room, to my bedroom. It’s finally time to pack.

I don’t have all of my clothes at the moment as Anne insisted on doing some more laundry, though I know it will only be washed again when I get back. Slowly but surely the suitcase starts to fill. In go the gifts for people at home carefully wrapped up and protected. Once I receive the remainder of my clothes, the suitcase still looks quite empty. I have used up and donated a few things but I didn’t expect the suitcase to look so bare. I practically had to sit on it to close it when I was packing at home all those weeks ago.

The rain continues to fall and I know that I won’t make it to the beach. I guess I have already enjoyed the best of the Sri Lankan sun. I write up a couple of days worth of entries for the blog as the Internet had been too poor to do so before, and I have been non-stop lately. I catch up on my book as I have been reading fewer chapters for the same, latter reason.

I watch my final Sri Lankan sunset fall and enjoy my last evening cup of tea here in this apartment. I am handed a big pink book by Anne and am asked to write a testimony. I write plenty and thank each of them for all that they have done, they really have gone above and beyond. If anybody would like to stay here (or you know of anybody going to Sri Lanka), their website is http://annemaisonnette.com/ – they come highly recommended, especially if you are doing a medical elective and want to experience real Sri Lankan food and get to know a local family. I have a photo with Anne before dinner, when I give her a gift biscuit set, and to her son a big bag of Jelly Babies and a bag of Haribo. I hope he shares some with his brother!

After 9pm I try and check-in online. It goes well at first but then after two attempts it seems that there is a fault with their system and the process cannot be completed. It just says to proceed to the desk as normal so I suppose that’s what I shall have to do. I have decided to have a driver from here to the airport tomorrow; whilst being pricey by comparison, it will be much easier.

And so begins my final 24 hours in Sri Lanka…

Day 59: 22/09/12

Two.

It’s an easy night’s sleep for both of us. Anne comes to collect the tray of plates from yesterday and I introduce her to Dave. He then has a bit of an induction into the ways of the house here. Anne brings us both one of her generous Western breakfasts of omelette, sausages, toast, fresh fruit smoothies, and tea. As Anne leaves, Billy comes in and checks for geckos, followed by… uh-oh… the blind cat. Anne leaves us to it and within seconds of her departure, the blind cat does another wee!!! NOOOOOO!!! It sprayed the door: it looked more territorial than the previous time where it just looked lost and frightened. We can’t help but laugh and I get rid of the cats. We have the rest of our breakfast and get ready for the day. Dave pays Anne and goes off to the gym.

I shower and pack my bag, getting to the bus station in Karapitiya for 11.30am, where I meet Dave. Philippa and Rachel are running behind with our plans to go to the beach so they text us asking that we go ahead without them. We catch a couple of buses and by the time we reach Unawatuna it is raining lightly. We are going to a different part of the beach today, farther down the strip. By the time we reach it, the clouds have disappeared. We take two sunbeds, order a couple of drinks, and enjoy the sun. Philippa and Rachel find us about 40 minutes later and take two adjacent sunbeds.

Whilst Dave relaxes, three of us go swimming, the water being much calmer on this side. We wonder if it’s because of the rocks in the distance; perhaps they have some effect on how it hits the shore in different parts. As I am swimming out towards Rachel and Philippa, what do I see? A turtle swims underneath me! I can make out its patterned shell but sadly it swims off and we’ve lost it. We enjoy the water and get out to have some more time in the sun. I read more of Notwithstanding, which has been funny in most chapters, though the current chapter is a bit difficult to get enthused about. Dave goes snorkelling and tells us he has followed a turtle for a while. Perhaps the very one I saw earlier. He goes back into the water and the three of us relax until…

Drip… drip… drip-drip-drip… some clouds have formed but it doesn’t seem bad enough for rain. Give it a minute and sure enough, I’m wrong. The rain gets heavier and heavier, the sky darker and darker. Tourists hurriedly pack up their belongings and run for shelter. Dave seems to have packed as many bricks in his bag as possible haha, but I grab the lot and the three of us run in and find a table. As the weather gets wilder and the waves taller, we worry about Dave. We try and find him but soon enough we see he’s on his way. We order some lunch and drink, which sadly isn’t all that great. The company however is wonderful. The rain only grows stronger as the afternoon goes on. Philippa has a Monopoly card game so we play that for a while and before we know it, it’s getting dark. I had better get back.

We pay the bill, pack up, and make our way to the main road. On the way, the girls notice a jeweller that they have been meaning to find as they made an order but the shop never seems to be open when they come by. They don’t have enough money to make the payment here and now, but the shop owner has their jewellery ready. He gives it to them and tells us that his friend will drive us in his tuktuk to Galle for free so that they can use an ATM. Much better than riding the bus! We squash in, in the darkness, Philippa on Rachel and Dave’s laps, and arrive in Galle. The driver receives the money to return to the jeweller and we are dropped off at the bus station. With Dave and Philippa heading to Colombo tomorrow to watch the cricket, and my planning to pack all day (so unlikely that I will make it to the beach to see Rachel) I guess this is the time for goodbyes. Some goodbye hugs later and I leave them to catch the bus to Karapitiya.

The bus seems to take forever and by the time I get back to Karapitiya, I am greeted by torrential rain. The street lights are out and I don’t have my torch. My flimsy umbrella barely protects me but it’s the best I have. I put it up but realise I need to get back quickly. With only the make-do lighting in the roadside houses and the hospital, I run my usual ten minute walk home, bag over my shoulder and umbrella waving in the wind. I must have looked like a complete lunatic. I make it back soaked through, let Anne know I have returned, and dry off in the apartment. Dinner, a Skype call, and a little packing follow before…… Zzz…

Day 58: 21/09/12

Three.

Today is my last day on ward 01 and my last day as an elective student. The time has passed so quickly and although this is quadrouple the amount of time Peninsula students spend in a department (in a restricted time period), it still feels just as short. I make my final walk to the hospital and enter ward 01.

We attend a brief ward round and as it is Rachel’s last day in paeds also, we take a few pictures. She is going to obstetrics next week, Dave finishes on Tuesday and will travel, leaving Philippa as the only elective student on paediatrics. After some picture taking, the doctor that knows my name summons a class for another session on the assessment and initial management of the acutely unwell child.

“We had better test you!” he says to me. I am called up to do the first case. I stand behind a table in front of Dave, Philippa, Rachel and a group of local students (with a few young patients looking on round the corner). On the table, there is an infant manikin lying on a sheet. Behind me is a board to consider my thoughts before the child’s arrival to the ED, and to my left there is an emergency trolley full of equipment, however I must instruct my “nurses” (two local medical students) which equipment I want for this child specifically. I feel a tad nervous but am ready to get going. He tells me the child is called Tom and we are in London (Phew! No tropical diseases then?). He is six months old and his mother is worried as he has been short of breath for two days. I instruct the students about which equipment I will want and I write up a differential diagnosis list, the lead diagnosis being bronchiolitis. I start my ABCDE exam and there is so much information to consider its difficult to keep track. I give him oxygen and nebulised bronchodilators, and reassess. It turns out the case is bronchiolitis after all and Tom’s alright now, hooray!

Dave is called up afterwards. His patient (Stephen) has suffered vomiting and diarrhoea. He writes up a differential and gets going with the assessment and initial management. It was much more difficult than mine but Dave seemed quite cool and collected. Afterwards he told me how stressful the situation feels but it didn’t show. The consultant tells us we did well and then teaches us for a bit before agreeing to sign my elective host form. I take some more pictures and say a few goodbyes before making one final walk along the corridor, out of ward 01 and out of Karapitiya Teaching Hospital.

The four of us decide to grab lunch and eat it at the girl’s accommodation in the Faculty. We watch some TV before heading to Unawatuna. The sky is blue and we enjoy the sun for a few hours. We go for a swim in the sea which is wonderful. As the sun starts to fall we move over to a table and have a drink and a chat. In the distance we spot something which puts us in fits of laughter. I suppose you kind of had to be there, but there is a European looking man taking pictures of a woman that he must know. She is in a bikini and is making the most obviously set-up, ridiculous poses you could possibly see, and the man is snapping away as if they are live on some fashion shoot. She lays back on the shore and pulls some crazy pose, clearly forgetting the strength of the waves and receives a pelt from one which makes the whole situation funnier. Then she stands up and seems to be trying to run in slow motion!! He chases after her and she waves her hair around and keeps pulling all these weird poses. I guess they take their holiday snaps seriously.

The girls invite us to dinner at their house which sounds wonderful. Dave doesn’t have a place to sleep tonight so the girls suggest that he uses Ethan and Sam’s old rooms. We catch two tuktuks to Food City in Karapitiya, buy some things for dinner, and head to the apartment. We shower off the sand and grit, and the dinner is being prepared. I feel a tad guilty that I don’t have anything to do as everyone is so organised and has done most of it already. I’m not sure stirring is a very significant contribution but it’s all I can find. We serve up our rice, beef and vegetables, and watch some TV. We enjoy a cup of tea and a chat, and it is realised that the rooms offered to Dave are locked and they don’t have a key. I give Anne a ring and she doesn’t have a spare room but as I have a spare bed, she is happy for him to stay there.

Just after 11pm we catch a tuktuk the short distance to Anne’s Maisonette (because the area is poorly lit and apparently a tad unsafe so late). I grab some bedding for Dave and I have a quick tidy up as I got changed for the beach in such a hurry today that the room is a bit of a tip. We chat for a while but eventually our busy day gets the better of us both, and we fall fast asleep.

Day 57: 20/09/12

Four.

There are very few students on the ward as they are in clinic today. I find Dave in the classroom eating his breakfast. We chat for a while and then go to the ward to see what’s going on. We meet Rachel who is also waiting for things to get going. Then an old lady walks over to us smiling with a little toddler in her arms. This little girl is the abuse case (there are two on the ward currently) that I mentioned a while ago. The one where the mother has psychiatric issues and made claims about being pregnant and her mother (who is this very lady) attacking her with a bat. These accusations have been deemed as false and with the father on the ward too, it all seems like a happy family. The little girl has become fond of Rachel who often carries her to give her tired mother a break (whom the ward staff suspect has a very low IQ rather than mental health problems). The little girl reaches out for her and Rachel scoops her up. Then the little girl reaches out for me and I carry her for a while before giving her back to her grandmother as a round assembles.

We join the ward round and see many patients in quick succession. Mycoplasma pneumonia, meningitis (the patient was not isolated), thalassaemia, post-streptococcal glomerulonephritis, Dengue fever, and lymphoma are among the cases seen today. The consultant (who is head of the department) starts asking me questions about the final patient who is suffering from an uncommon type of Shigella bacteria, commonly referred to as bacillary dysentry (as it derives from the specific species’ name). He asks me how we treat it in the UK but as it is so unusual I must admit I am uncertain. I tell him what I think and luckily he is quite pleased (I looked up the answer when I got home, so for any medics wondering – it’s 1. Oral rehydration; 2. Paracetamol for fever [& lower febrile convulsion rate]; 3. Antibiotics – ceftriaxone preferred or other 3rd gen cephalosporin [Cochrane review]; 4. Is notifiable disease; NB anti-motility agents are contra-indicated).

Afterwards we examine a couple of patients and Dave goes to the trauma centre as he doesn’t want to go to the class. Rachel and I sit in the class and chat while we wait for the consultant to arrive. One hour later, it seems as though we are not having a class but the students here are so obedient they dare not move. We are somewhat immune from the consultant’s often fearsome teaching style so we stand up and go to leave. The students are shocked that we dare leave but I guess that’s a cultural difference really. When a consultant doesn’t turn up to a CPC mini-lecture at home, we are quick to abandon ship. I go to the Faculty and donate my lab coat before going to Food City. I get some food for the weekend and pick up a gift for Anne. I consider chocolate but as I don’t have a fridge and would need to borrow theirs, it would be a bit of a spoiler. There is a nice biscuit set (kindly labelled ‘Gift’ in the name) so I decide to get that.

I spend the afternoon in the apartment, trapped inside by the raging storm outside. At one point I notice Anne’s partly blind and deaf cat is sat outside my apartment curled up in a ball trying to avoid the worst of the rain. Despite the… ahem… “incident” before… I can’t let him sit out there. I open my door and go to scoop him up but he meows and runs away from me and down the stairs. He seems to prefer the torrential rain to me. Cheeky sod.

Day 56: 19/09/12

Five.

The heat beats me down as I make my way into the hospital through a side gate, up a set of stairs and along the corridor to ward 01. I join a group with the doctor that knows my name. Nothing seems to be happening so I take the opportunity to try and find one of the sisters. I brought a few medical things with me to Sri Lanka – sterile gloves, non-latex gloves, plasters, vitamins and a few other things – and I’d like to donate them to the paediatric ward. I meet a nurse and try to tell her what I want to do but the nurses don’t speak any English and no amount of signing is going to help. I will have to find someone to translate later on.

The doctor that knows my name enters the nurses bay and greets me. I ask him if he will sign my elective host form this week, to which he says he will. Then he says I should come and see a jaundiced neonate with him. I follow him and a group assembles along the corridor around a couple clutching a young baby in their arms who is visibly yellow. The doctor asks us to consider what we would like to ask in the history, what we would look for on examination, and what investigations we would like to do. We ask some questions and it’s a very useful talk, though no opportunity to do the examination myself.

Afterwards, the advanced paediatric life support session from the other day seems to have resumed. He calls up a couple of students and they go through their ABCs with assessing acutely ill children, this time the cases focusing on severe vomiting and diarrhoea. The doctor then invites me to have a go, as I am in the higher year group of the elective students here. Not today, but it would be tomorrow or perhaps Friday. I feel a bit nervous but I say yes, I think it would be a good experience, although their style is slightly different to ours.

The class is relatively short and we hear that there is going to be a practical session at 2pm at the Faculty about neonatal resuscitation. That sounds great; I’ve never been taught anything about neonatal resuscitation besides paediatric basic life support. I am scheduled to be with the neonatologists for six weeks in a few months time so this would be a great head start. I employ the help of a local student and give one of the nurses a John Lewis bag full of equipment. I get my form stamped by the Faculty, go home for lunch and then join Philippa and Rachel where we eventually find the correct place. We take our seats and a young woman introduces the session and shows us the equipment. Sadly, it gets worse minute by minute. The main problem is that she goes from speaking poor English, to a mix of English and Sinhala, to Sinhala only. Luckily, the consultant joins before long and she delivers the session in good, clear English. As there were so many students and such little time, only a minority got to practice the resuscitation but I made some good notes and now I know what to expect in a few months time.

Day 55: 18/09/12

Six.

Sleep was easier and yesterday’s nose has finally turned its tap off. I still feel full of a headcold but I think it’s getting better from here. Shower, breakfast, ward 01. I join the round with Dave, Philippa and Rachel. It passes bay to bay but is so fast and with so many students we can barely understand what is happening.

Once it finishes we decide to examine a young girl in the high dependency unit. She is about six, wide awake, wears a Pokémon stick-on tattoo on her right arm and giggles constantly. I listen in and can hear a systolic murmur loudest in the mitral area. It is difficult to tell whether it is throughout all of systole or just specific parts because she is tachycardic, and as children’s hearts beat faster than adult’s when they’re healthy, this makes the job really tough. She is due to have an ECHO. The chart indicates she is febrile so we wonder about rheumatic fever.

Dave has only been on paediatrics for the past six weeks whilst the three of us have all spent time on the general medicine ward, so he is keen to see it. We take him along and I wave at Eva who is still here after all this time. There are two new German students, along with the two Australian boys. I speak with the senior registrar and ask about any interesting cardiovascular patients we could examine. Although the staff and I didn’t exactly chat those weeks ago, we are both pleased to see each other. I am directed to bed 25. Dave speaks Sinhala and gains consent for me. The patient is an elderly man with a displaced apex beat, quiet diastolic murmur, bilateral crepitations and peripheral pitting oedema. His pulse is regular and I find nothing else to note. Dave examines him and we compare our findings. I think he’s in heart failure and I think it’s because of mitral valve disease. Then we go and examine a patient with hepatomegaly among other signs of chronic liver disease. Dave wants to see more patients but I don’t, so I head back to ward 01 whilst he continues making the most of his half-morning on general medicine. Then we have a class and I head back to the apartment.

The Internet seems to get slower by the minute, which with little else to do besides watch the rain fall, is making the time drag a bit. I hope I will be able to check-in online on Sunday night for Monday’s flight. I am looking forward to my fish and chips welcome home.