In defence of my profession

The movie "Awake" has just been released. It dramatises the rare phenomenon known as "awareness during anaesthesia", basically distorting facts and portraying certain situations in a totally untruthful manner. I've copied below a recent press statement from 'Ontario's Anesthesiologists' (anesthesiologists being the North American term for what the Brits/Aussies/Kiwis call anaesthetists). All the statements about standard of care equally apply when anaesthesia is administered by a trained professional in any country I'm familiar with.

Ontario's Anesthesiologists Criticize the Film Awake

    TORONTO, Nov. 30 /CNW/ - Ontario's Anesthesiologists expressed their
disappointment in the movie Awake, which was released nationwide in Canada
today.
   Dr. Stephen Brown, Chair of Ontario's Anesthesiologists, a section of the
Ontario Medical Association, criticized the film, stating, "The film highly
distorts the practice of anesthesiology and the condition known as anesthesia
awareness, in a manner that is irresponsible and that could jeopardize the
ability of medical professionals to properly treat patients in need of
anesthesia care."
   Said Brown, "While we appreciate the fictional nature of the story, the
movie gets the science completely wrong. The greatest problem with this is the
effect it may have on patients, many of whom may become unnecessarily fearful
about necessary medical procedures. As doctors, we encourage patients to take
an active role in their care. I believe that this sort of misinformation will
impede patients in playing an educated role in their care."
   Among the inaccuracies of the film, Ontario's Anesthesiologists noted:

   <<    -   The film and its publicity materials indicate that anesthesia   
   awareness occurs to 1 out of every 700 patients undergoing general       
anesthesia. The actual incidence of the condition is likely closer to       
1 in 15,000 for routine surgeries. Further, the incidence of       
anesthesia awareness is much rarer in the vast majority of cases, and      
only approaches the 1 in 700 ratio if one considers very high risk      
cases such as in some traditional cardiac anesthesia and trauma       
surgery.    
 -   The film indicates that anesthesia awareness is a condition in which      
the patient is fully paralyzed and fully awake. This is not usually       
true. While in the very rarest of cases this can occur, most forms of       
anesthesia awareness involve a slight sense of awareness of the       
surgical procedure, including possible memory of sound as well as a       
general awareness that the surgery is taking place - but not an       
experience of pain.    
 -   The cardiac surgery conducted in the film was not conducted according      
to standard modern anesthetic procedures. More modern procedures       
lessen the incidence of anesthesia awareness and increase the ability      
of the anesthesiologist to detect and remedy any possibility of       
anesthesia awareness.    
 -   The patient in the film (played by Hayden Christensen) was described       
as "paralyzed", but was in fact only partially immobilized, as       
evidenced by eye and facial movements These movements are indicators       
to the practising anesthesiologist which allow the anesthesiologist      
to detect the possibility of awareness.   
  -   In the movie, anesthesia was apparently provided in a single, initial       
dose. In reality, for a general anesthetic, the anesthesiologist       
would administer an initial dose, but would continue to administer       
anesthetic during the entirety of the procedure, and would monitor       
the treatment throughout.   
  -   The movie presented an anesthesiologist who was inattentive and       
intoxicated. This would obviously not be an acceptable level of care       
in Ontario hospitals.   
  -   The pre-operative assessment of the patient in the movie was       
completely missing. Ontario's Anesthesiologists conduct a thorough       
interview with patients who are to undergo anesthesia. And, for       
complex surgeries, such as cardiac surgery, the anesthesiologist       
further assesses the patient at the time of surgery. This assessment       
allows the anesthesiologist to determine whether the patient is       
within a group that is at a higher risk for anesthesia awareness and      
to properly determine the form and amount of anesthesia to be       
provided.    >>

   Ontario's Anesthesiologists believe that patients and their families
should be involved in their treatment and should be well informed about their
medical options as well as any risks associated with treatment. However,
Ontario's Anesthesiologists are disappointed that the movie Awake has failed
to accurately portray anesthesia treatment and, as such, may have a negative
impact upon the proper treatment of patients.

Kee Thuan Chye - articles & interview

I've actually been back from my holiday a week now - updates in next blog! Was sending out this mass mail and thought it wouldn't look too out of place on this page, so here it is:

Hi all,

Kee Thuan Chye is a Malaysian journalist well-known for speaking his mind. He started an editorial for The Star in April 2007 which was promptly canned after 2 articles after the government warned The Star.

Here are links to the 2 articles (2nd one is what got him sacked):

No bulldung please.

This land is our land.

Also, here's a recent interview where he speaks out on current issues:

Kee to playing the fool ... again.

Cheers, Nav.
(your ever-loyal left-wing chest-thumping head-banging whisky-swigging fire-poking shit-stirring antipodean correspondent)

p.s. If anyone else cares, the lead singer of Quiet Riot just passed away. Everyone should download Metal Health (shame on you if it's not already in your collection) tonight and listen to the music & lyrics in a dark room, illuminated only by your computer screen, and just fuckin' lose yourself.

Pre-holiday excitement

Been a good day so far. Afternoon teaching was cancelled (we were told to do self-directed learning ... like that was gonna happen!) so I have time to catch up on paperwork. Have an eye list tomorrow morning, hopefully it's all cataracts so I get to practice my sub-tenon blocks.

Couldn't find any colour pics of sub-tenons, but these show the 3 main steps quite well: (1) make a small cut in the conjunctiva, (2) slow dissection under Tenon's capsule down around the globe, (3) insert blunt cannula thru the tract you've made [while holding bit of conjunctiva] and inject local anaesthetic mixture when you've curved round the globe [I inject 4-5 ml of a 7ml solution containing Lignocaine 2% 3ml, Bupivacaine 0.5% 3ml and Hyaluronidase 150 IU/ml 1ml]. This is all done in an awake patient after topical anaesthesia with Tetracaine and Oxybuprocaine.

Going home to Malaysia this Friday (landing on Saturday morning). Apart from a short 3 days in January, this'll be my first trip in 16 months. Too long for someone who usually averages 2 trips a year. First stop is KL on Saturday for a bit of 'merry-making'. My next post will be after I recover from my hangover.

Guns 'N Roses - 3 July 2007, Christchurch

Thought I should write about this before the memory fades away (after all, you can't put your arms around a memory ...... anyone else get that?)

While I was studying for my Anaesthetic exams, I read in the paper that GNR were gonna be touring Australia and NZ in June/July 2007, with the Auckland show being held 3 days before my exam. I was swearing at myself ... such crappy timing!

GNR was my favourite band during a huge chunk of my teenage life (before finally being superseded by Iron Maiden when I was 16 or 17). I can remember buying the Use Your Illusion 1 & 2 cassette tapes in November 1991 just after they were released. I ended up listening to side 1 of Use Your Illusion 1 over and over again (I never bothered with side 2 ... would just rewind the tape and listen to side 1 again). This actually went on for a couple of months until I had this brainwave that the other 3 sides that I hadn't listened to yet might actually be just as good! Even now though, Right Next Door To Hell, Don't Cry, Perfect Crime, Bad Obsession and Back Off Bitch (all on side 1 of UYI 1) still take me back to weekday mornings in my living room, waiting to go to school when I was 13 (I was in the afternoon session) with GNR playing in the background. I still remember the lyrics to all their songs from the 5 studio albums. They were also the first albums I owned where you could clearly hear swearing in the lyrics ... and a lot of them as well. A lot of my time was spent turning the volume down at key parts of certain songs, to avoid incurring the wrath of my parents.

Ok, enough reminiscing about my childhood (for this post anyway). The tickets for the Auckland show was snapped up in an hour ... and the organisers subsequently added another show in Auckland, this time 2 days before my exam. Great fucking help that was to me! But wait .... a few hours later another announcement was made that they were adding another show ... this time in Christchurch, a whole day after my exam! I was absolutely stoked, to say the least. Fate finally dealt me a good hand - wasted no time in taking leave for that day.

Now, I know what everyone's thinking: "It's not really GNR anymore, it's just Axl" or "It's not GNR without Slash". Seriously though ... I know it's not the same GNR from 1987-1993. I decided it wasn't the same as soon as Izzy Stradlin' left the band, let alone Slash. the fact is, this is the closest thing that comes to the old GNR. Not even Velvet Revolver (with Slash, Duff and Matt Sorum) would qualify cos they only sing 1 or 2 GNR songs live. And even when they do, you know it's Scott Weiland and not Axl. So as long as the current incarnation of GNR had Axl singing close to what he sounded like (apparently the years of snorting cocaine hasn't been too kind to his vocal cords), I'd leave Christchurch a happy man.

Even though there were probably a good 200 people in front of me in the line outside the stadium, because I turned right when almost everyone else turned left after the main doors opened, I ended up with only 5 people ahead of me at the last doors (there were 2 entrances to the standing area on either side). I sprinted as soon as these doors opened and ended up right in front of the stage against the railing. And there was no fucking way I was moving for anything or anyone. Some high school kids ended up next to me, and they were talking amongst themselves. One of them tried to say something funny, and his mate goes, "Haha, that's about as funny as a stillborn". That cracked me up.

Anyway, show opened with Rose Tattoo, this old Australian hard rock band with a bluesy tinge to them. They've been around since the 70's. Their music was a little bland I have to say, but it was pretty good to hear Nice Boys Don't Play Rock 'n Roll played by the band who wrote the song (I'd only ever heard the GNR cover version). Also, I swear their frontman, a guy named Angry Anderson, was gonna have a stroke on stage at some point during the set. Next on was Sebastian Bach (for those who don't know, he's the ex-frontman for Skid Row). Now this guy, has taken great care of his voice ... it was absolutely pitch perfect. And he's a bloody good entertainer as well. I'm not a big fan of Skid Row in general, but was screaming along with everyone else when he belted 18 And Life and I Remember You.

After Bach left the stage, there was this sort of edgy anticipation throughout the crowd. Is Axl gonna throw a tantrum and not show up? (Axl doesn't turn up on stage before 11.30pm). Is he gonna leave halfway? Is he gonna give a shit performance and not really even try? Is this really happening? And then, the intro to Welcome To The Jungle started playing and 12'000 people went absolutely mental. Everyone was screaming the song. Girls (hot ones at that) started taking their tops off to try and get Axl to acknowledge them. GNR played at least 7 songs from Appetite For Destruction, which was just awesome. Only 3-4 songs from UYI 1 & 2 though. Of particular significance to me were It's So Easy, Mr Brownstone, You Could Be Mine, Out Ta Get Me and Nightrain. That last one is a song about my favourite cheap wine (Night Train, 17.5% alcohol, made in America) that I used to buy for RM20 (NZ$7.40) a bottle when I was 18-19. I could write a few posts on my experience with Night Train alone (GNR altered the spelling to avoid paying royalties). The crowd was understandably more quiet when some songs from the forever 'soon to be released' Chinese Democracy album were played but they didn't sound too bad. The pyrotechnics on stage were pretty good too.

By the end of the night, my ears were ringing but I left the venue knowing that I had been witness to the closest thing to what was once the biggest rock band in the world, and I had a huge smile on my face despite the cold wind and rain at 1.30 in the morning.

My dying tongues

My sis asked me to help her out with a letter the other day. Sent her a few suggestions, after which she txted back saying "It has to be in Malay, not English". I thought to myself, just translate the bloody thing. Then ... i tried to do it myself. Bugger. There was no way I could come up with any direct translations for some words, let alone a whole phrase (without sounding like someone from elementary school anyway). I always knew my command of Malay was in decline ... but to this extent?

A little background info here: When I went to school in Malaysia (through the public education system), every subject in school was taught in Malay (except other languages, like English, duh!). From the age of 7 right up to 17. I spoke to my teachers in Malay, gave speeches in Malay, learnt classic Malay prose .. hell, I was even in the school's Malay debate team (and the English one as well). I speak English at home by the way.

Outside of school though, most people use colloquial Malay ... not the type you use in the classroom. This I can still speak, though it takes a while to come up with the right words sometimes. Useless when you need to write a letter though.

Why has my Malay become so bad? Simple. I don't use it anymore. Even in Malaysia after high school, I only ever needed to use colloquial Malay to get around.

The same thing has happened with my Cantonese. This I was never taught, but picked it up cos all my friends in school spoke it while I was growing up. I can still understand it, but again, thinking of the words takes a while. Again, the decline started after high school. Made new friends in KL, all of whom spoke English (rarely the case in smaller towns like the one I grew up in). Obviously used it even less in NZ (unless you get me really drunk ... the words seem to come out easier then).

At least my command of Punjabi has constantly stayed the same - abysmal! I can still only name types of food, numbers up to 15, family designations, simple verbs and certain household items. The food is very important :D

Of foreign doctors and terrorist cousins

By now, most of you should be familiar with the case involving Dr Haneef in Queensland. If not, here's a quick recap:

Bungled terrorist attacks in London and Glasgow (no one injured and 1 terrorist dies when his vehicle goes up in flames with him in it). Many of those involved identified as Muslim Indian-born foreign doctors, practicing in the UK. One of the suspects had a cousin practicing as a doctor in Brisbane (Dr Haneef, also Indian-born, having moved from the UK a few months ago), who was caught while trying to leave the country on a one-way ticket. Various claims made by the police to justify the arrest. Charges laid and then later dropped due to lack of evidence. Turns out, all Dr Haneef had done was give his terrorist cousin his UK SIM card when he was leaving the UK (almost a year before the terrorist activity) because he had no use for it once he left the country. The SIM card was not used in the attacks. Dr Haneef subsequently released from custody but has had his work visa cancelled (due to his failing the "character test"), so is unable to continue working the Australia.

Now, I'm writing this because I am a foreign doctor (well, sort of. I'm New Zealand-trained but born in Malaysia). Also, I had a terrorist cousin. His name was Kalwant Singh Sidhu-Brar (Sidhu-Brar being my real surname, some people prefer to just use Brar - [the Brar clan is a subset of the Sidhu clan]). Some newspapers referred to him as Kalwant Singh Gumti (Gumti being the name of his [and my ancestral] village in the Punjab). He was a Sikh militant, involved in the armed uprising against the Indian government in the quest for a separate Sikh state called Khalistan in the 1980's and early 90's. His paternal grandfather and my paternal grandfather were brothers (my grandparents on both sides of the family migrated to what was then British Malaya, so I'm 3rd generation Malaysian).

Before I tell you his story, let me just say that having read into the background of the Sikh separatist movement, and the events that provoked a demand for a separate state (they were essentially being screwed by the Indian central goverment) I support their motives but not their methods. Depending on your point of view, they are either freedom-fighters or terrorists. I tend to favour the latter term, based on the fact that many innocent Hindu civilians were gunned down in order to provoke the central Indian government. That's not to say I'm absolving the other side either - many Sikh youth who were picked up for questioning ended up dead after police torture (some for just being seen talking to a known militant).

On a quick side-note, I hate the way the word "terrorist" is bandied about these days. After Sept 11, everyone and their grandmother is a terrorist as long as it suits American interests. Why weren't the Irish Republican Army ever called terrorists by the American media? Was it because of the huge Irish Catholic immigrant population the US that provided moral (and some monetary) support? The same with the "freedom-fighters" in Kashmir not usually referred to as terrorists so as to not offend Pakistani sentiments, with Pakistan of course being central to America's "war on terror" (or as Borat so aptly put it, "war of terror")

Anyway, this story starts in August 1986, when General (retd) A. S. Vaidya, Chief of the Army Staff at the time of operation Blue Star, was shot dead in Pune by two Sikh assailants. If you don't know what Operation Blue Star is, go Google it or search on Wikipedia (and while you're there, look up Indira Gandhi's assasination and the subsequent anti-Sikh riots). Then, in August 1991, the Indian Ambassador to Romania Julio Ribeiro (who also happened to be the ex-Director General of Police in Punjab) was seriously wounded in Bucharest. The assailants in both cases were eventually captured and in the former case, sentenced to death.

In October 1991, the Romanian charge d'affaires in New Delhi, Liviu Radu, was kidnapped by four armed men as he drove to his office. The Khalistan Liberation Force and 3 other militant Sikh separatist groups jointly claimed responsibility for the kidnapping. My cousin was involved in the planning, if not the execution, of the kidnapping. I remember reading his name in the newspaper when I was young after this incident (and Dad pointing it out to me that we were related). They demanded the release of Sikhs facing the death sentence for the assasination of Vaidya. A Romanian official was chosen due to the fact that Ribeiro was posted to Romania, hoping that it would set off a diplomatic row between the 2 countries. The problem was though, that no one gave a rat's arse about some Romanian official in India and there was barely any follow-up media coverage internationally. He was eventually released unharmed after 48 (some sources say 23) days unharmed, with none of the demands met.

One of the men on death row was a close personal friend of my cousin. My cousin himself had gone underground prior to this, and was all set up to escape and live overseas (all the main funding came from sympathetic Sikhs based mainly in Canada and the UK) until he heard about his friend's situation. After the Romanian official was released, my cousin was gunned down in a police shootout (the police commonly manufactured these shootouts after torturing suspects to death, although this was not the case in this instance).

So there you go, a few similarities between Dr Haneef and myself. If Australia ever comes up with an immigration form asking "Do you or did you have any family members engaged in terrorist activity?", what do I tick?

References:
The Illustrated History Of The Sikhs - Khushwant Singh, Oxford University Press, 2006.
http://www.time.com/time/magazine/article/0,9171,974111,00.html
http://www.sikhsentinel.com/sikhsentinel0309/harpalsingh1.htm
http://www.hindu.com/2007/09/27/stories/2007092756051200.htm
http://www.rediff.com/news/2002/feb/05inter.htm

Dr Wenger's Diagnosis

Clicking on the title should take you to the article on The Guardian's website. A good interview with Wenger on the general state of football.