First 9/11… now 8/22?

Demonstrating (what counts for me as) great personal restraint, I have held back the obvious Lord of the Rings puns all day as we bid farewell to the two Athlone Cooling Towers… but I can’t help note the allegory to the more unfortunate US event fading rapidly into our combined histories.  Ours, of course, came as less of a surprise – but still somewhat unexpected.

The cooling towers have been a feature in my landscape for as long as I’ve lived in Cape Town: my whole life.  I still recall driving past them as a child every time we set off to Betty’s Bay for a weekend.  The coal power station was still operational then, and one could see the cascades of water through the air intake fins at the bottom of the tower: a living example of the principles of physics that I was foggily beginning to grasp at the beginning of the long process to creating light pour from handy switches around the house.  My father could explain the entire process all the way to Somerset West, and I was enthralled.

The Athlone Power Station shut down years ago, and since then the towers have gradually declined.  I once missed a chance to abseil from them during a rescue practice because of an ophthalmology tut I was too scared to bunk: what a waste 😉  The city council announcement that they had become structurally unsound and would be demolished didn’t come as much of a surprise, but it certainly jerked a few Capetownian tears.

Despite the girl and I both being badly post-call, neither of us was at all willing to miss something being blown up almost in our back garden.  I had done some reccie work on my trusty Dakar (LOTR reference coming:  it’s name is Hasufel) and selected a spot along the river just across the highway from the towers.  We arrived with dog in tow about 90 minutes early, picnic in hand, and selected a prime piece of river frontage replete with uninterrupted view for my cameras (HD video and DSLR).  As the time passed if became more and more festive, with people from all walks (and limps) of life filling the bank.  Everyone was delightfully polite and careful not to obstruct each other’s views; children played together and Kaptein earned much attention and praise.

With about 30 minutes before the 12h00 detonation time I settled in behind my tripod and did a full systems check: ready.  My watch had been zeroed to SA Standard Time before leaving home.  Occasionally we’d catch a waft of sound from the press tent on the golf-course across the river.  Time passed slowly but lazily, with a festival air.  At T-minus 5 minutes I decided to start my video camera rolling at T-3 just in case of an early detonation, and was shielding it from a short rain shower when we heard a sound drifting across the river…. “…. 3…. 2….. 1….”

AAAARGH!  Just over 4 minutes early!  Everyone scrabbled.  I hit record and yanked my SLR out of my jacket as the explosions zipped across the face of the tower and was shooting within seconds, but the more distant tower was already consumed in dust and smoke.  An unwelcome stranger charged in front of all of us, blocking the video camera, and earning a bout of curses from the petite aunty next to me…. then everyone was whooping and cheering and asking “Did you get it?”

Well, sorta.  Enjoy, the end of the Athlone Ladies.  Click on the images for an enlargement – the second in the series is a beaut to check out the bending and fault lines.

Damn the b@st@rds who hit the button early: I hear the Argus didn’t get a single good photo from their guys on scene and the E-TV reporter looked more shocked that the gulls perched on top when the bang went off 😉

The new view:

Random Photo – Welcome to South Georgia

Right Whale Bay on South Georgia - diversity, desolation, life and death

South Georgia is without doubt one of the most beautiful places I have ever visited.  I first set foot there in Right Whale Bay, late one summer evening, and was confronted with pandemonium – more seals than I had ever seen before, mixed with more penguins than I could comprehend, surrounded by other birds on the ground and the wing combining to create a cacophony amidst a visually overwhelming background of sheer splendour:  beauty, terrifying austerity, diversity, desolation,death, and life in abundance.

What my real job is like…

This is doing the rounds, and has us all in stitches (especially in the anaesthesia department, of course).  No orthopods were harmed in the making… but my head does hurt.  Click the image or link to play.

Anaesthesia vs Othopaedics

To be entirely fair, I thoroughly enjoy doping ortho cases, as I have an interest in regional blocks.  However, this conversation bears such striking resemblance to conversations that I’ve had with previous ortho’s that it can’t be allowed to go unknown 🙂  Each to his own, I suppose: when all you have is a hammer…

Random Photo – Ice in Cierva Cove

It’s not only the wildlife in Antarctica that is photogenic: the landscapes, sea and ice combine in innumerable ways to create awesome beauty.  While slowly cruising around Cierva Cove on the western side of the Antarctic Peninsula, the groups was captivated by a pair of crab-eater seals.  Turning around, I shot the sculpted ‘bergs beneath a brooding sky instead.  I don’t shoot in black-and-white often, but the emotion was unmistakable unavoidable.

Cierva Cove under a brooding sky in black and white

Random Photo – Caracara

On New Island in the Falklands, this Striated Caracara became very curious while I lay in the grass and watched the clouds drift past.  The ‘Johnny Rook’ has a bad rep – some would say well-deserved – but I found them charismatic and delightful… perhaps because they, too, are a little rough around the edges.

Caracara wondering if I am available for lunchClick the image to enlarge; click here to learn more about this interesting bird.

Random Photo – Giant Petrel

For the want of time (ok, let’s face it: self-discipline) to write posts, I thought I’d start trying to regularly post excerpts from my photographic collection.  It is very likely that the photographs will not be contemporaneous, as  I’m seldom ready to post pictures while still travelling, but hopefully they will be interesting.

Today’s image is from my last expedition with Cheeseman’s Ecology Safari’s to the Falkland Islands, South Georgia, South Orkneys, South Shetlands and Antarctic Peninsula.  It was taken at sea, shooting from the stern of the Polar Star, of one of the most ubiquitous Southern Ocean birds, the Giant Petrel (aka ‘Jeep’, from ‘GP’).  Flight photography from the stern of a pitching ship is always entertaining and frustrating at the same time, but I really enjoy the composition of the shot:  I tried for hours to get another bird in the frame in a position that is ‘just right’.  Shot with Canon DSLR and 300mm lens, hand-held.

Giant Petrel on the wing, shot somewhere in the Southern OceanClick on the image for a larger view.

Wilderness medicine reading for today – Salt-water Aspiration Syndrome

I have resigned myself to the fact that I will never be a world-famous blogger.  This is not due to a lack of the ability to write (well, ‘document’, perhaps, as true writing implies artistry) nor a dearth of material (the world around us is just full of quirky stuff) but rather my utter laziness.  It takes a serious effort and some time out of the day to place posterior on pew and pen to paper… metaphorically speaking.  In any case, with that admission out of the way, I have decided that for as long as the gumption lasts I will try to post a very brief blurb on whatever wilderness medicine literature or related information I happen to be reading.  Even if it’s just a link or two, this will hopefully be a small contribution to the field, rather than just my meandering musings.

Hence, here is ‘What I’m Reading in Wilderness Medicine Today’:  Salt-Water Aspiration Syndrome.

SWAS (I’ve just decided that is the acronym from now on) is reasonably well documented in the literature and should be familiar from any talk or chapter on drowning/near-drowning.  You will likely recall that two different clinical pictures emerge dependant on whether a patient has aspirated fresh or salt water; major concern in the former is the loss of surfactant and resultant atelectasis and lung damage, while the latter is characterised by pulmonary oedema, fluid shifts, metabolic acidosis and later hypoxia, depending on the inhaled volumes.  The original paper describing the phenomenon is attributed to a Dr Edmonds in 1970 (see Edmonds C, A salt water aspiration syndrome, Mil Med 1970 Sep;135(9):779-850; I have not yet been able to acquire the article).

Why am I suddenly interested in this?  Well, yesterday we were geocaching out along the coast.  There was a big sea running, and the onshore wind had piled sea foam in great masses along the shore.  We suddenly realised that the Labrador had gone missing, and after 15 minutes of running around calling (there were ostriches nearby, and I thought he might be chasing them) we realised that he had possible tried to run ‘over’ the foam and was now ‘submerged’ amongst the rocks… or had gone into the wild sea and was almost certainly already dead.

We both plunged into the foam, wading and feeling with our feet.  The foam was discoloured from particulate matter and very salty, and new ‘waves’ threatened to swamp us as the wind brought more from the adjacent sea.  You will imagine my relief when I felt a furry body beneath foam which was up to my neck, and the furry body turned out to be a live but very sick dog.  He had been trapped under the surface for 20 minutes.

Initial symptoms were bloodshot eyes, coughing, tachypnoeic with a very wet chest with ronchi/rales and hypersecretion.  He was still able to ambulate, however, and so we hoofed it to the car and sped off back to Cape Town and the veterinary hospital.  By the time we arrived an hour later the cough had settled but he had developed a harsh wheeze throughout the respiratory cycle.  He was admitted on IV fluids and prophylactic antibiotics for monitoring, and 24 hours later is gradually improving.

Mild cases of SWAS (not uncommon in divers) generally resolve with rest within a few days, while more severe cases require positive pressure ventilation (a very good response to CPAP/PEEP has been observed).  Expert opinion and the literature I’ve been able to track down concur that there is no role in for corticosteroids.

Resources to have a look at:

This is by no means an exhaustive review, but please drop me feedback if you find it informative and/or useful.  I have not yet been able to find a case report of aspiration/pneumonitis from sea foam in either human or canine in the literature yet, so if you are familiar with such a case please let me know.

Last (happier) picture – the dog and I after we found him.

Huh? WildMedic?

…is pretty much what you have to be asking.  Well, there is method in the madness 😉

“WildMedic” is a username/avatar I concocted many years ago to express my twin loves of the wilderness and medicine, and the natural combination thereof – wilderness medicine.  By the time my mouse button returned to the raised position after clicking ‘confirm’ I realised the potential confusion – few patients want to think of their doctor as wild!  (Caring, considerate, learned, professional… all good… but wild?)  In the end, however, it stuck.  There _is_ something wild in my heart, but wild like a wolf running silent through a starlit snowy forest:  untamed but controlled, spirited but spiritual.

I began blogging when I journeyed to Antarctica as the expedition doctor and leader of the South African National Antarctic Expedition in 2007-2009, which you can read about in my AntarcticDoctor blog.  Writing brings me some pleasure, and the positive feedback has spurred me to continue, albeit in a sporadic fashion.  Hence, we arrive at this WildMedic blog.  Expect varied content – I write when the muse strikes and photograph when faced with inspiration – but please enjoy, comment when you desire, and click the little red button in the top right hand corner when you tire…  😉

AntarcticDoctor will continue later this year when I return to Antarctica for the summer, but I will make sure that the content is frequently cross-posted here, so set up an RSS feed or check back frequently.

Bergschrund

Musings of a wilderness doctor

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