The Chorten, and a bunch of medical stuff

One day after work we went to the National Chorten. Avoiding the obvious question, a chorten is a Buddhist religious monument/shrine that contains saintly relics or is dedicated to the memory of a holy person. The National Memorial Chorten is dedicated to the memory of the third king of Bhutan, a devout Buddhist who did much to further the teachings of the Buddha in the 20^th century. We walked clockwise around the Chorten (this is the only direction that one can walk). I had had a difficult day, and the walk, the dedication of those surrounding me, and the environment were quite calming.

The Chorten itself; note scale!

Elderly ladies praying with prayer wheels

We have been lazy, and have not done much after work. We do a bit of shopping, either eat out or make dinner, and then watch Indian television (or the BBC or CNN). Eileen writes to her friends, and I do my sleep studies and/or pound away at the blog.

 Work has been a bit challenging, and has been going differently from last year.  There have been fewer ICU patients than last year. It feels as though the resources available to diagnose and treat patients have contracted, and I have encountered knowledge deficits that I thought we had addressed. I have been asked to see a large number of patients on the medical wards. This has been a consultant’s dream, in that I get to just write my impression and plan, and don’t need to worry about massive documentation.  In fact, massive documentation is impossible in that (a) I can’t take a history in Dzongha, (b) many patients have no idea of their health history (some don’t even know their date of birth—born in the boonies a long time ago) and (c)testing is by and large unavailable. I have seen three cases of lung abscesses. TB excluded in all of them. One case is almost certainly the right middle lobe syndrome from hell; she might be the only RML syndrome that I ever recommend for operation. The youngest patient is 16. I was told that "we Westerners are not as susceptible to these diseases." Bronchoscopy is pretty much out of the question. We’ve (not the royal we, me and the equivalent of the hospitalist) seen a case of a hemithorax obliterated in a young man with a primary brain tumor, the CT of the chest is pending. Today, I was asked whether or not a woman in her 30’s should be referred to India for mitral valve replacement because of mitral stenosis from rheumatic heart disease. Thank you, UpToDate!!!! (for the record, valve cross sectional area was 1.25 cm2 and anything but sitting made her breathless. Send me a postcard from Calcutta…)

For those of you who are less than thrilled with SCM and the EEHR, let me offer an alternative perspective. I have been working in paper for the past 10 days, and the amount of time wasted on admittedly dumb things imposed by meaningful use, insurance companies, compliance, those zany folks from Allscripts, and unintended consequences created by yours truly and his minions are more than offset by an orderly, available database of information that you can use to really take care of your patient. I know that electronic medical records has had a rocky road at MaineGeneral, but from the perspective from the male medical ward at Jigme Dorje Wangchuck National Referral Hospital, we are so, so fortunate.

This coming weekend we will spend in Paro, about 50 km away. There are lots of old monasteries, the Paro Dzong (fortress), and Tiger’s Nest.  More on that when we return.