Thursday, May 28, 2009




How long is a Piece of String?... ooops Cable?!




At the conclusion of our week of heart surgery we had dinner at an Italian restaurant in Nairobi. Cliff, our 'perfusionist', held a sweep-stake where we all had to make a guess as to how long the cable was from the maintained power socket to the Cardio-Pulmonary Bypass Machine in theatre. We all put a £1 into the pot.

Ivy won! It was 29 metres or 95 feet!

Monday, May 25, 2009

Clifford Longley.


I love listening to radio 4 - unfortunately there are occasional bits of grit in my breakfast that have to be endured like "Thought for the Day" on the "Today" programme. This morning I had that awful sinking feeling as I listened to the contributor.

Clifford Longley is a journalist with a long career commenting on religious affairs so it is more with a sense of depression rather than any other emotion that I say what I am about to say. I barely know where to start in unravelling his confection of platitudes... any way here goes.

The notion that people make ethical decisions based on whether they believe they may be rewarded or punished and that atheists, having no such motive, can actually operate on a higher ethical plane leaves me speechless. This is such a childish notion.

The adult reality is that people make ethical decisions based on the worldview they hold to. If one is a thoughtful Christian one makes Christian decisions. An atheist will make choices consistent with that worldview. If it happens that one is an atheist who follows a none Social-Darwinian ethical process then one does so because one instinctively knows (by God's 'Common Grace'!) that such a course is right even if one finds oneself acting in a logically inconsistent manner. That is hardly operating on a higher plane.

The bishop CL was damning on air I suspect was actually pointing out that our values arise from the worldview we hold to be true. Reading between the lines of CL's garbled account the poor bishop was probably simply affirming a Christ centred worldview (which is his job afterall!) but that obviously went completely over CL's head.

A Christian may act unChristianly/Atheistically. An Atheist may act unAtheistically/Christianly. It all depends on the operating worldview. But this is all beside the point because merit is not earned in God's eyes by what we do. That implies that correct ethical choices put us in God's good books but that is not how it works! We all foul up from time to time - so the adult issue is how now do we get right with God given the reality of our failure? As a Christian I believe in Jesus not in my capacity to make correct ethical choices. A Christian, by definition, is someone who has come to a point of repentance rather than the media caricature of someone who is self-righteous, ie someone who believes that they always make correct choices!

As a Christian I seek to make ethical and personal choices consistent with the world as it actually is; though in my weakness I often feel brow-beaten by media pundits pushing the official line and find myself compromising against my better judgement. And when I do fail my primary concern is not fear of being punished it is the sense I have of not having 'walked worthily of Lord'. Others may make ethical choices on worldviews they are in a better place to explain. I seek to make choices which please the Lord, so reward/punishment are not the primary consideration! The ethical debate lies elsewhere entirely in the nature of reality and truth and relationship with God.

Clifford Longley's piece this morning is merely yet another example of the infantilisation of religious discussion in the country when it is crying out for informed comment and debate.

Sunday, May 24, 2009


Return from Africa!

I arrived back from Nairobi a couple of hours ago. In all our "MEAK" team did 17 operations on children with congenital heart defects including some of the more complex procedures yet attempted; Truncus, TGA etc.

Sadly one of our patients died midweek which was a low point for us all. We did have our successes - a baby girl with a huge VSD and failing heart had no clear left lung fields on X-Ray. Not only was her heart huge but she also had a raging chest infection. We did physio on her and suctioned out lots of gluey secretions. This is her X-Ray now - hurrah! we have some air on the left side!

The other highlight was that we did the first ever "Switch" for Transposition of the Great Arteries ever attempted in Kenya.

I'll write more about all of this but right now I'm exhausted after a sixty-five hour week and this will have to suffice for now!

Wednesday, May 20, 2009



The Kenyatta National Hospital in Nairobi.

During our time in Kenya we are aiming to do three major cardiac operations each day. I was speaking to the manager here this morning who told me that they only have the resources to do two or three a week normally; so in our time here our team could clear 2 or 3 months backlog! Which is quite an amazing thought!

I am also given to understand that we did Kenya's first ever "Switch" for 'Transposition of the Great Arteries".

Thursday, May 14, 2009


An Amusing Sign by the road en route to the Kenyatta National Hospital in Nairobi.

A group of us from the PICU will be based there 15th-24th May 2009 as part of a team doing open heart surgery.


Nairobi sunset.



Wednesday, May 13, 2009




Crack PICU team,


Nairobi May 2008.


Claire Barker, Fiona Lynch, Natalie Robertson & Tim James

(I'm behind the camera!)






Peritoneal Dialysis.

During our 2008 trip to Nairobi on a Cardiac Surgery mission one of our post op children went into acute renal failure. I improvised a PD set, as well as made our own bicarbonate dialysis fluid. The advantage of taking a dinosaur like me along is that I remember how we used to have to do things twenty+ years ago!


Take a one litre bag of sterile 0.9% Saline for IV use and remove 350ml using an aseptic technique. Discard this 350ml.

Using an aseptic technique add the following to the remaining 650ml bag of 0.9% Saline; 300ml Glucose 5%, 10ml Glucose 50% and 40ml Sodium Bicarbonate.

Properties of this solution are as follows Sodium 140mmol/L, Glucose 2% and Bicarbonate 40%. PLEASE NOTE THIS SOLUTION CONTAINS NO POTASSIUM! Normally one would add 4mmol/L of Potassium Chloride depending on the patient's serum K+ level; however if the patient is hyperkalaemic use a reduced amount, eg if their potassium level is 5-7 add just 2mmol/L, and if the patient's level is >7 add no potassium to the solution.

Start with Fill Volumes of 10ml/kg. In over 5 minutes, dwell 10 min and drain over 15 min. And repeat the cycle. This will draw off some excess water as well as correct the patient's electrolytes and acidosis. Monitor patient's fluid balance and serum electrolytes regularly until the patient's kidneys recover. Until they do recover restrict the patient's fluid intake to 2ml/kg/hour if they weigh less than 10kg, and if they are upto 20kg give 1ml/kg/hour.

For larger patients give a maximum of 40ml/hr if they weigh more than 20kg (please note this is NOT 40ml/kg/hr but 40ml total volume per hour!)



















Facebook.
I recently joined the Facebook crowd........................ so if you can't get enough of me here you can always look me up there!

(ps Gym today: ran 3.52 Km in 20 mins, weigh 91.0 Kg.)

Friday, May 08, 2009

More Training.


Today I completed my annual "Moving & Handling" mandatory training. And, as a special treat, we had a short session on the respirators we are being fitted with in case of pandemic Swine Flu. 3M Respirator type 7500 with p3 filters........................... so I'm okay!.........................

Tuesday, May 05, 2009

The Age of Aquarius!

Among the wide range of gadgets we use in PICU to help support the sick kids we have is this one. It is an "Aquarius" haemofilter produced by 'Edwards Lifesciences Services GMBH'. We use this for Continuous Venous Venous Haemofiltration (CVVH). We generally use this when the children are in acute renal failure and need excess fluid removing &/or their chemistry correcting. Occasionally we will have children who need a drug dialysing out.

In essence we draw blood out from the patient through a large intra-vascular catheter called a 'vascath' by means of the "blood pump" which is the red roller pump [top left]. The patient's blood is pre-diluted with a dialysis solution [Multi-Bic] drawn from a reservoir bag slung beneath the machine by the green pumps before entering the blood filter in the centre of the picture. Excess water is drawn out from the filter by the yellow pump into a waste bag also underneath the machine (not shown). The filter will also correct the patient's blood chemistry and pull out any other waste products too.

Depending on the size of the patient (and they can be infants all the way up to teenagers!) we will select the appropriate size filter and the various parameters for an effective treatment. This is programmed into the computer screen at the top of this picture.

Renal Replacement Therapies is one of my 'specialities'.
Covenantal Objectivity.


If someone died on the way to their baptismal service do you believe that that would be "objective" evidence that they were not saved?