...I have been mostly eating...Chinese food! (well...what did you expect?) The last five days has gone by ridiculously fast, and I only have a fortnight left in this fair city.
Monday was a bit slow, just my first day in hepatobiliary - met secretary, tried to find out who my supervisor is (and failed) and watched a few random things. Tuesday was a bit more exciting - early research meeting (not so exciting, and yet again I worry about PhD students' grasp of simple facts, but I digress...) The rest of my day was taken up by what's apparently the hardest, most involved procedure in the hardest abdominal surgical specialty - a liver transplant. The girl (27, with Wilson's disease - didn't get a chance to look at her eyes, unfortunately) was on the table by half eight, and setting up the anaesthetic gear alone took well over an hour. In no particular order, she required an arterial line, two central venous lines, a pulmonary artery catheter, and ten syringe drivers filled with various anaesthetic goodies.
That was only the start of the medical technology. The anaesthetists also had a cell saver (which filters red blood cells out of the waste that gets sucked out of the operating field, stops them from sticking together, and makes you a bag of packed red cells that you can infuse straight back into the patient, saving you from having to use as much donated blood), and the surgeons had an Argon Beam Coagulator - which looks like a magic wand shooting lightning. It's a step above normal diathermy (the electrical knife that seals as it cuts) which is important as the liver is full of small blood vessels, and bleeds very easily.
While three surgeons are cutting out the old liver, the donated one (which came from someone in a road accident, I think - there were a few small lacerations on the surface) is prepared next door - vessel cut to the right size etc, all while it's kept on ice to stop it going off. Once the diseased liver is out of the patient, they plumb the new one in. The whole process takes 12-18 hours (I didn't stay for the full thing) because of the number of important ducts and vessels that have to be joined up. It was quite a cool thing to observe, though, and I got two RoA boxes signed off - always a bonus.
On Wednesday, I slept though the census meeting (getting a bit bored of "relatives were informed of the grave prognosis, and the patient succumbed at...") then spent the rest of the day in the hepatocellular carcinoma (liver cancer) clinic. It's fairly rare in the UK (only only 1% of all cancers; it's more like 7.5% over here) due to differences in genetics and (more importantly) hepatitis infection rates. They've started immunising all children against hep B virus which should hopefully reduce the rates of the disease. A few patients got some fairly bad news and all of them took it very quietly - I think is just the reserved Asian personality again. Much the same happened on Friday (see below).
Thursday was another slow one. There's nothing on the timetable for hepatobiliary students except operating theatre all day, but the only thing on the list was a hepatectomy (liver removal - not the whole thing, I should add, just half) which (1) I've seen before and (2) is a bit dull. I checked all the other theatre lists and there was not one thing I particularly wanted to watch - trying to catch a bit of cranial neurosurgery for interest's sake, but they didn't have a list - so I went to Starbucks and then went home. My plans for a swim and wander round Mongkok (electronics/camera/computer shops) were destroyed by the abberant weather - in the last week, the rainy season has arrived. Boo!
Today...today I went in for the hepatobiliary clinic - just general HBP. A few sad stories - untreatable cancers of the liver and pancreatic head - and a few more promising ones. Oncologists really need to learn when to stop, though - one woman was basically being used as a testing station for every type of chemotherapeutic agent under the sun, none of which has any evidence base. Stop pouring into her veins drugs which will (1) do nothing and (2) make her feel worse, please.
I had no time for lunch - had to dash to the bank to change some traveller's cheques before the weekend, as my plan was to go to Macau on Saturday (more on that later). The rain was torrential this morning, and waterproofs are a bit too warm, so I also purchased an umbrella. Black, wooden handle - very City of London gent.
I got the bus back up the road and, while it wasn't too wet, it was quite windy. I spent my afternoon watching ERCP - endoscopic retrograde cholangiopancreatography - which is a combination of endoscopy (telescope down your throat) and radiology (X-rays). They use a special side-viewing endoscope to find the point in the bowel where your bile ducts pour in their contribution to your intestinal juices, and then stick a tube (not the endoscope, it's far too big) up the hole. The tube is then used to inject a dye into the bile ducts - it's radio-opaque, so if you watch on X-ray while you inject, you get an image of the biliary system. You can find stones, cancers, strictures and all sorts with this rather clever technique - today there was one stone, one normal, and one liver cancer.
During the ERCP session, a few bleeps went off (as they always do) but one grabbed everyone's attention - the consultant's bleep went off to say that typhoon signal #8 had been hoisted! The signals are #1, 3, 8, 9 & 10 (for historical reasons I can't be bothered to explain) and #8 is the cue for Hong Kong to shut up shop. People leave work (the stock exchange shut 15 minutes into its afternoon session), schools close, and most public buildings shut too. I, of course, being used to this sort of weather, decided it'd be a good idea to walk home. I think I'd missed the good bit of the storm, as there were lots of bits of tree lying around, and my waterproofs did their job admirably - I thought the better of putting up my £3 umbrella in 30mph gusts of wind. I was passed on the road by loads of buses with their "FULL" lights on, presumably with people heading home from work to batten down the hatches.
I made it back to St John's in one piece - it was more wet than windy, to be honest - and found the stuff I'd left to dry on the balcony a little wetter than when I left it. I also appear to have lost a sock - I'll have a look in the daylight, but it might have been blown out to sea. Bye bye sock! At the minute, I'm pondering how the weather might affect my weekend plans - the Macau government's weather site is down, and the Hong Kong forecast looks pretty bleak for tomorrow. If the #8 signal stays up, it's probably unlikely that the ferries will run, too. Think I'll get up early, check the weather, and if it's bad I'll try and plan something indoors - might head over to Kowloon again as there are a couple of museums I could go to, lots of shops, and afternoon tea at the Peninsula if I can be bothered...
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