Home thoughts from abroad.

Sitting in my hotel room in Bruges at the end of a hectic International Fluid Academy meeting in Antwerp. Well done Manu Malbrain, ain’t no one gonna rain on your parade. Manu is moving to Brussels so this may well have been the last Antwerp event, privilege to have been there. For my British friends whose geography of Flanders may be thin, that is like moving from Derby to Nottingham (or visa versa) in terms of distance.

The organisers will rank the presentations, and no doubt publicise them, so I will share some personal moments. Firstly, the steady state Starling principle has by no means been widely accepted, so it was great to hear From Paul Marik that East Virginia trainees are given my BJA paper for mandatory reading. I in turn congratulated Paul on discovering that “sepsis” may be no more than acute severe scurvy. He tells me there has still been no deaths from sepsis in his practice. Further reports forthcoming. We even shared a selfie (how modern is that?) Seriously, a privilege to meet the great man. Talking about old times with Patrick Honore, Mervyn Singer, Monty Mythen always good for my soul. Robert Hahn’s published works over a decade or more gave me a way to reconcile the steady state Starling Principle with clinical practice, so I was truly humbled to find myself talking to him, and presenting my paradigm for prescribers alongside his masterful presentation of his interpretation of the data I pored over. At the end he presented me a copy of his perioperative fluid therapy text book 2nd edition, and I will send him a copy of Farag & Kurz (Springer) with chapters by me and the Anglo-American physiologists who have inspired me. Both books have been very well received in reviews.

Sitting next to a clinician at dinner (sorry, have forgotten your name) who tells me he PASSED his exam in South Africa after answering question about Starling with the Revised version. Examiners had never heard of it, but their professionalism shines through in accepting the fact that sometimes Examiners can learn something new from Candidates. Many delegates were specifically interested in the glycocalyx model, so I was very sorry that I was filibustered out of presenting my main lecture by lack of time discipline. Perhaps I will record and post on this blog.

Finally, it was shocking to find that declaring colloid osmotic pressure support a pointless therapeutic exercise was met with real anger from one or two quarters. Is this a modern social phenomenon? But this did not distract from the pleasure of networking with so many dedicated trainees and experts whose unifying purpose is to deliver safer care.

Post Scriptum.  I drew attention to the use of gum acacia for resuscitation from wound shock during the Great War. I am always moved to be in the vicinity of Flanders where so many young men died so that I never even had to lift a firearm in my own life. I will never forget them. The following verse is well known, it was written by Canadian physician John McCrae;

In Flanders fields the poppies blow
Between the crosses, row on row,
That mark our place; and in the sky
The larks, still bravely singing, fly
Scarce heard amid the guns below.

We are the Dead.   Short days ago
We lived, felt dawn, saw sunset glow,
Loved and were loved, and now we lie
In Flanders fields.

Take up our quarrel with the foe:
To you from failing hands we throw
The torch; be yours to hold it high.
If ye break faith with us who die
We shall not sleep, though poppies grow
In Flanders fields.


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