Sunday, October 26, 2014

Rodriguez Touring Down Under for Possibly the Last Time - Review of Sydney Opera House Concert Hall performance 23 October 2014

Rodriguez enjoyed considerable success as an artist in Australia, New Zealand and South Africa.  It is interesting how there was such little interest in his work in his home country of the USA.  Maybe things would have been different if his time was in the internet era rather than in the 1970’s when radio airplay and record/cassette tape distribution was 100% at the mercy of record company executives.

After limited success in 1970’s, he returned to a reclusive existence in Detroit until in the late 1990’s, when a dedicated team of fans from South Africa began their search for the “Sugar Man”.  This re-discovery is what has brought him back into our lives.  He is now about 72 years of age and regularly tours the strongholds of his fan base.

When his latest concert series for Australia and New Zealand was announced, fans were quick onto their keyboards to acquire tickets.  The general feeling was that this was likely to be his last tour down under. Initially two performances at the Sydney Opera House Concert Hall were announced and when tickets went on sale, they were sold out in about 15 minutes.  There was the usual anger associated with ticket scalping when tickets were almost immediately and readily available on Ebay Australia at approximately 4 times the original ticket selling price.  An additional three performance dates at the somewhat less salubrious Enmore Theatre were subsequently announced.

Our small group of curious Rodriguez fans attended his performance on Thursday 23 October 2014.  On a Thursday evening, the late start performance time of 9 pm meant that getting into town was less stressful than would normally be the case after a full day at work.  It was advertised that there was to be no supporting act and that was fine with us.

To our surprise, there was a single song support act from a person unknown and never identified to us.  She quietly entered the stage and sat on a stool with an acoustic guitar.  She looked as though she might be related.  We politely applauded after a short and slightly off key performance.  Just as quietly, she left the stage and now, anticipation was at an all time evening high.  Our bucket list check box next to Rodriguez’s name was about to be ticked with another lifetime achievement confirmed. 

Slowly, a dark figure plodded through the shadows supported by two of crew members.  The crowd erupted in cheers and screams as the legendary Rodriguez was lead out onto centre stage.  It was obvious that his eyesight is at least as limited as has been reported.  Although we were only in the fifth row from the front and in the middle of the row , we could barely see his face.  He was wearing a large sun visor that protruded some 15-20cm beyond his hairline, which cast a Mordor like shadow over any facial features. 

Considering that he used to play with his back to an audience, we will take his on-stage shyness as having come a long way.

He said nothing but gave a half wave of acknowledgement to the audience before launching into songs from a back catalogue of two shortish albums.  A couple of filler cover songs helped take his total on stage performance time to around 75 to 80 minutes.  He played what the audience wanted to hear, which was essentially every track on the album Cold Fact. This album had a place in every self respecting record collection of the 1970’s.  He barely said a word to the audience although at one stage, he did mumble the names of his supporting band members.   He did leave the stage after about 70 minutes of performing for the obligatory request that the audience beg for an encore.  Just before the second song of the encore, he mumbled into the microphone ‘this is going to be our last song’ and these were possibly the first intelligible words that I could make out the whole evening.  He and his crew then bowed to the appreciative audience.

I enjoyed this concert and had no regrets about being there that evening.  The reality was that there was an elderly man on stage in the concert hall of the world famous Sydney Opera House who called himself Rodriguez playing a series of ‘okay’ covers of this demi-god of a man who called himself Rodriguez back in the 1970’s.  His follow up album to “Cold Fact” was actually called “Coming From Reality” but I’m going to put all that aside and remember him with the same romanticism and adulation as the fans who have quite possibly have seen him perform for the very last time in Australia.

Thursday, October 16, 2014

First Changes of Suprapubic Catheters. A Need to Change a Stupid Policy

A suprapubic catheter is a tube that is placed through the lower abdomen into the urinary bladder as a way of managing problems associated with the storage of urine or emptying of the bladder.  Placement is a minor surgical procedure and essentially involves filling the bladder to capacity and then literally stabbing the lower abdomen with a sharp pencil like device (trocar) through which the catheter can then be introduced.  A syringe port allows us to inflate a balloon located towards the tip of the catheter with water and this helps hold it in place.

(Image from

Within days, a scar tissue type reaction forms around the tube and within a couple of weeks, there is  channel lined with scar tissue which we refer to as a tract.  This channel or tract acts a conduit through which the tube can be easily changed. Patients who have these suprapubic catheters (SPC) ideally should have them changed every 4 to 6 weeks.  Changing these catheters is a simple task and expertly performed by nurses.  In hospitals where there resources do not have such nursing expertise, the task is often relegated to the most junior and least experienced of medical officers, interns.

A policy regarding the first change of a SPC came into being a number of decades ago and the exact origins of this policy are unlikely to ever be determined.  The policy is that the first change of the SPC should be performed in a hospital. And thereafter, SPC changes could then be done in the community. It is one of those unwritten policies that entered healthcare folklore in the total absence of evidence.  It is a folklore tightly held by a number of administrative or officious types who want nothing of a challenge to this dogma.

I recently had a twitter rant over this as a result of an elderly patient of mine being literally forced to return to hospital for a simple change of SPC that could have been done in the community.  I could not care less about the wastage of the precious hospital resources but what I did care about was the enormous disruption associated with having to get the patient prepared and transported to hospital to have a simple procedure that takes about 10 minutes to perform.  We tried reasoning with the person in charge of the local community nurse services to only receive a blunt response that it was POLICY that the first change of SPC be carried out in the hospital.  I asked for where this policy is written but we all know the reason why this request was not responded to  - obviously there is NO SUCH WRITTEN POLICY. 

Okay, are we subjecting the patient to risk by doing the first SPC change in the community or are we placing the community nurse under untenable litigation risk?  Of course not.  What is the worse that arise from a bungled SPC change?  The catheter may not be able to be replaced because the tract was too tortuous or the catheter balloon might be blown up in the middle of the tract instead of in the lumen of the bladder.  This happens rarely and something that could just as likely occur in the hospital.  If a problem occurs, is it a dire medical emergency? No. A urethral catheter can generally be placed until a replacement SPC procedure can be arranged or they can be sent to the hospital.  The long term sequelae from such an event – remote if anything could be thought of. 

Outside hospitals, it is the community nurses who perform regular catheter changes week in week out.  They are highly skilled and to state that they lacked the capability to do a first change of catheter is nothing short of insulting.  I am sure that both you and I would much rather have a skilled community nurse perform a catheter change at home rather than trudging our way to hospital to have a less experience intern medical officer do the change.  Interestingly, many of the community nurses that I have interacted with are in themselves quite happy to do the first change but are not permitted by their superiors who remain opposed to change. 

Lets get back to evidence.  A highly talented urology nurse consultant, Colleen McDonald from Westmead Hospital, performed a study onirst changes of SPC in the community versus that performed in the hospital environment. I really do not need to go into the detail of what the study showed.  The title of the paper says it all.

McDonald.C & McFarland,M. (1999).  First Suprapubic Catheter Change...from Hospital to Community....A Clinical Practice Change.  Journal of Stomal Therapy Australia, 20(3), 14-15