Anesthesia in Australia: inefficient efficiencies

The third post in my series about my experiences as as anaesthesia fellow in Australia and the cultural differences in the way anaesthetic care is delivered.

I have been working in Australia for over three months now, including a brief side-trip to attend a conference/vacation in Bangkok, Thailand  (see photos).

Chris and me in front of one of the many elaborately decorated buildings at the Grand Palace, Bangkok, Thailand

Prior to coming to Australia, I had been told that Aussies think Canadians work too hard, and that Aussies were more relaxed because they just work more efficiently.  Efficiency is a matter of interpretation.  The state of Western Australia is still benefiting from a mining boom and has a lot of money to spend inefficiently as well.  In my 3+ months here, the main recurring themes are redundancy and inefficiency, and overstated casualness. And of course, alcohol, beaches, kite-surfing, cycling, and summer music festivals.

It's just casual....
Western Australia is known to be the more relaxed state, and people here like to live up to that reputation.  They try very hard to show it.  This culture is evident in not only the colloquial language (more on that soon), but also in the interprofessional and doctor-patient relationships in health care.  Once medical professionals and allied health professionals get to know each other and work together, it is natural to drop the fancy titles and call each other by first names.  It is almost seen as aggressive to call a colleague by the title "Doctor".  In fact, the polite way for a doctor to introduce themselves to a new patient is:

"Hello (insert patient's first name).  My name is Amy and I am one of the anaesthetic doctors."

And for the remainder of this doctor-patient relationship, the patient knows me primarily as my first name.  This is a contrast to the level of formality I maintained when I was back home.  When in Rome....

Aussies like to shorten words, even medical words.
We use a lot of acronyms in medicine.  Almost every medical condition can be written as a 3- or 4- letter acronym.  At least I thought so, until I began learning even more acronyms and short forms here.
Some examples:

Example #1:  NOF - an acronym for  Neck Of Femur fracture.
At home, we would call these "femoral neck fracture" or "intertrochanteric fracture", or simply a "hip fracture".  The first time I heard this term, the conversation went something like this:

Surgeon:  "Amy, we are booking a NOF..."
Me: "A what?"
Surgeon: "A NOF"
Me: "A NOF?"
Surgeon: " Yes, we're booking a NOF"
Me: "A what?"
Surgeon: "A NOF"
Me: "Huh?"
Surgeon: "A NOF"
Me: "A nof... ok, WHAT'S A NOF??"
Surgeon: "Oh, you know, a N-O-F"
Me: "No, what is a NOF?  It sounds like an acronym I am not familiar with"
Surgeon: "a neck of femur fracture"
Me:  "Oh! ....Oh?... Oh boy..."

This was a very inefficient conversation.

Example #2: "Sux Apnea"
I am not biased against orthopedic surgeons.  This one is an anaesthetic problem.  I discovered this oversimplification/confusion while giving a mock exam to a group of registrars.  This conversation went something like this:

Me:  "Tell me about malignant hyperthermia"
Registrar #1:  blah blah blah blah...uhhh?
Me:  "Ok, tell me the genetic basis for this disease"
Registrar #1:  "blah blah blah... uh... EU and EA genes...??" 
Me:  "Ok, let's pause here.  Does anyone else want to comment that?"
Registrar #2:  "I think she is getting MH mixed up with Sux Apnea"
Me:  "What did you say?  Sleep apnea?  A genetic disease??"
Registrar #2:  "Not sleep apnea, I said 'sux apnea'.  She was talking about the genes related to sux apnea"
Me:   silence... thinking....
Me:  "Are you referring to pseudocholinesterase deficiency?"
Registrar #2:  "Yes, sux apnea."
Me:  "Wait, you're telling me  you call it 'sux apnea' rather than pseudocholinesterase deficiency?"
Registrar #2:  "Yes. I guess we call it that too.  But 'sux apnea' is shorter."
Me:  "But pharmacohogically, a proper dose of sux should make every patient immediately apneic.  Isn't that confusing?"
Registrar #2:  "Uh, yeah..."

This was also not an efficient conversation, and potentially dangerous if one side didn't understand the other in a clinical situation.

Example #3:  "Scoline allergy"
 During a weekend on call, working on my own, I found out how dangerous these Aussie short-forms can be.  "Scoline allergy" was marked on a patient's anaesthetic record.  The patient had been reviewed by one of the anaesthesia trainees with no other mention of how this would impact the anaesthetic.  One of the anaesthetic technicians brought it to my attention.  I've never heard the term "scoline" before this.  She told me that it's another word for suxamethonium, which in Canada, is called succinylcholine.  A so-called "allergy" to sux could actually mean a life-threatening anaesthetic disease.

There are many reasons why this casual oversimplification of words is also dangerously life-threatening.  This was also a very inefficient use of a short form.

Example #4:  "Do you want a Larry for this one?"
One of my anaesthetic techs asked me this question while preparing for a case.  The conversation went on something like this:

Me:  "No, the patient's name is not Larry, it's...."
Tech:  "I meant for the airway"
Me:  puzzled look
Me:  "Um, for the airway?  I would like an LMA for the airway"
Tech:  "Oh yeah, sorry, I forgot you are Canadian.  An LMA, ok.  A "larry" is an LMA. It's short for a 'laryngeal mask'."

The acronym LMA was the universally accepted short form for the term "laryngeal mask airway".  Little did I know there is an even shorter form for the acronym itself.  This conversation was also very inefficient.

"To Follow"
Bookings for surgical time, or rather "theatre time", are not made by surgeons.  They are made by booking clerks.  This takes away the ownership and responsibility of the surgeon.  It is also inefficient because the clerks don't know how much time is required for each case.  It also leads to a lot of cancellations.  Rather than a schedule with dedicated times allocated to each case, the operating room schedule, I mean, theatre list, looks like this:

8:00 - Case A
T/F  -  Case B
T/F  -  Case C
T/F  -  Case D

"T/F" stands for "To Follow".  So it is difficult to know how long each case is going to take, even for the surgeons themselves!  All the patients, A to D, are also asked to come into the hospital at 7am.  It makes it easy then for the doctors to see all the patients in the morning and rearrange the schedule if one of them "accidentally" ate breakfast or if the correct equipment won't arrive until later in the day.  But it is very inconvenient for the patient who arrives at 7am for an operation that won't start until 2pm, and it also blocks a bed in the pre-op/day surgery unit.  It is also not uncommon to cancel patients because the lists were overbooked.  So, to correct this, the other extreme occurs - underbooking, with large amounts of theatre time wasted.  The doctors don't really complain much, because in the public health care system, we are all salaried.  No one seems to complain that it is public money wasted. 

Fortunately, Western Australia is a wealthy mining state.  Until the mining boom busts, it is hard to predict any change in efficiency.  But I'm pretty sure Aussies will continue to shorten as many words as humanly possible.

Funny names Australians give their children

I thought we had a lot of non-traditional names in North America.  But I should have taken a hint when I said to someone "My name is Amy" and they asked "How do you spell that?". One day, I even found my name written on the white board in the theatre as "AIMEE".  Ugh.

Aussie's love to make up names just as much as they like to shorten words.  They also like to name their kids short forms of proper traditional English names as their legal names rather than the full version.  They also like to take away letters and add letters, which makes me wonder if they just don't know how to spell.  Then comes the racial thing.  In North America, some names will offer a hint to a person's racial background.  In Australia, they are mostly white and occasionally indiginous, but really mostly white.  So these names seem even more out of place.   Read on and tell us if you agree at the end...

Chris and I have complied this list of "Funny names Australians give their children" so far:

Ayden: Just to make "Aiden" a little different.
Bill:  Not short for William.  Legally, just "Bill". 
Chas-Lee: I'm pretty sure this is made up
Cher-Leisa:  I'm pretty sure this is made up too
Chershannah:  When asked about her name, this person said frankly "my mom made it up"
Chriss:  That's right, "Chris" with a double "S" at the end. Not even short for Christopher.
Cheryal:  I thought this was pronounced "Sher-ee-all".  But it's pronounced "Cheryl". 
Donaugh: This is probably the only authentic (Irish) name.  I just thought I sounded funny calling a man "Donna".
Jadan:  Pronounced "Jayden"
Jonay:  When said by an Aussie, it actually sounds like "Jenny"
Jasinta:  I thought this is usually spelled "Jacintha".  It's rare in Canada, but very common among white women in Australia.
Kipcharlie: Because middle names are for losers.
Sheen:  When said by an Aussie accent, it actually sounds like "Shane".
Symantha:  Australians don't know how to pronounce the letter "a" anyway.
Xzavaier: Don't get me started on this one....

And the kicker.....

La-a:  Pronounced "Lah-dash-ah".

THE POST TO END ALL POSTS (until the next post)

 I apologize for the absence of updates, but we had several weeks of nothing happening and then a couple weeks of furious picture taking which needed a lot of uploading just when our internet went down harder than a drunk on a spiral staircase.

Then there was a further delay because our landlord needed to send us three different internet access passwords, which really were just one internet password which he gave to me after managing to change a single character three different ways. I'm pretty sure he has some sort of middling dementia. I suppose that explains why instead of fixing the cable when I told him there was something wrong with the cable connection he bought us a new TV... and also why he forgot his car keys here... and why he left his bank documents here... and why he didn't feel bad about giving me his credit card number, birthday, home address and his mother's maiden name...

Ah well.

So here are a few snaps of our visit to the Fremantle anchor museum. I wasn't kidding when I said we were running out of things to do around here. It gets better soon, I promise.

Check it out. It's an anchor.

They aren't attached to the ground but they're heavy enough that I don't think anybody would try to steal them.

Here's a lorakeet. These guys are really colorful. And SCREECHY, gatdamn.

Not like the crows. This is the fountain outside our apartment. There're usually 3, each occupying their own spot on the dais, but 3rd place crow kept flying away whenever I took a picture.

Alright enough with boring pictures.

The real reason why we've been AWOL is that 2 weeks ago Amy and I met up with our friend Shef to go to Bangkok for 1 week. Amy and Shef were there to attend the World Anesthesia Congress. I was there to attend the World Wake Up Late and Eat Spicy Food Congress.

Don't tell the hotel but I broke their curtain rod. It's not my fault I'm a hulking uncoordinated goon by Thai standards.

We got there later in the day on Saturday and found this restaurant recommended by the New York Times.

There are two menus. Spicy...

and Hot & Spicy.

Food in Bangkok is really cheap. 1 dollar gets you 30 baht and each plate costs around 60-90 baht. This was our  first night in Bangkok. We didn't know at the time but the area we stayed in is popular for its cheap and tasty food.

After despicing ourselves, we went out and about after dark to see what the neighborhood was like.

Way fewer scooters than last time I was there 20 years ago, but still more than downtown Toronto. Even when you count all the hipsters.

Late night Siam Square Durian. In the stinky, stinky flesh.

Would you get a massage from Miss Puke? I read that everybody speaks English in the city but I didn't meet many people who did. This will be more of an issue when you see their t-shirt slogans later.

Next morning we decided to take a riverboat to see a few temples and the Grand Palace.

Central World is a massive mall attached to the hotel where the conference is. That's it to the left. It's like Yorkville if it was 7 stories with a 50 floor rooftop bar.

Out looking for breakfast our first morning before heading off to see some temples.

Waiting for a BK bus.

Drivers are so courteous here they share lanes with at least one other car and as many tuk tuks as possible.

So many Buddhas. Even on our way to see some Buddhas we ran into a bunch of Buddhas. 

I can't see the Buddha for the Buddhas.

The two most popular temples, Wat Arun (Temple of Dawn) and Wat  Phrakaew (Temple of the Emerald Buddha) are visible from the river, as is the Grand Palace. There are several riverboats that offer get-on get-off services for the day.

Decorating the front of the longtail boats for good fortune and to honor the river spirits.

Most of the boats on the river were driven by modified truck engines, rather than dedicated marine units.

Thai Buddhist monks. They have a very interesting set of rules as per http://www.thailandlife.com/thai-monk/227-rules-for-monks.html

There are seven kinds of offences. In the following list, pacittiya is not so serious and all a monk has to do is confess his fault to the abbot or at least two or three other monks.

-If a monk drinks intoxicating liquors, it is a pacittiya.

-If a monk tickles another monk, it is a pacittiya.

-If a monk swims in the water for pleasure, it is a pacittiya.

-If a monk frightens another monk, making him scared of ghosts, it is a pacittiya.

-If a monk, having shared a robe with another monk, uses it without the other party having relinquished his part-ownderhip, or given permission for its use, it is a pacittiya.

-If a monk hides any of the possessions of another monk, these being the bowl, robes, sitting-cloth, needle case and belt, even as a joke, it is a pacittiya.

I imagine April Fool's day is a somewhat muted affair at the monastery. Getting drunk? That's a pacittiya. Tickle fight? That's a pacittiya. Committing pacittiya? You better believe that's a pacittiya.

Wat Arun - very impressive in person. It's a lot bigger than pictures would make it out to be.

First stop off was the Grand Palace. You're not allowed to enter without wearing some sort of full leg covering, and there was no shortage of enterprising sarong vendors at the front to point out your bare leggedness which they will very kindly help you with.

This building houses the Emerald Buddha, which actually isn't made of emeralds. At least it comes in a nice building.

These pointy adornments of the roof are chofah, which represent mythical creatures known as garudas. A garuda is 50% human, 50% bird, 100% awesome roof decoration.

Seriously, look at these. Who wouldn't want to live in a building with a roof like that?

Soffit of the ubosot housing the Emerald Buddha.

Structural timbers holding up the roof. The security guards make you take off your shoes when you walk under the roof. For some reason, security guard shoes are allowed though...

Up close on the mosaic inlay on the exterior walls.

Nagas, half snake/humans, the sworn enemy of the garudas.

Just another day at the Grand Palace for this garuda.

Killing nagas and hanging with his peeps.

Unfortunately, no pictures of the actual Buddha are allowed. This particular Buddha has different garments depending on what time of year it is. This is understandable cause it was hella hot that day. April's the hottest month in Thailand. Also we had to wear pants on the temple grounds. I wore scrubs over my shorts and even then they were soaked through. Everywhere I sat there was a big sweat buttprint. 

This is a stupa, which represents different stages in the life of Buddha. I think this one represents nirvana/death of Buddha.

Amy and Shef getting stupa-fied

This massive mural encircles the entire perimeter wall.

On the way out of the Grand Palace we ran into these two Yakshis guarding the temple gates, presumably to ward off any pantsless trespassers.

I could have used one of these Thai snow cones. Not a great picture but he's planing a block of ice with a stationary mandolin type apparatus.

This is how hot it was that day: One of the scams we heard of before we left was one where they tell you the location you want to see is closed for some made up reason. Then they offer to take you to some other location just as good, except it's way over on the other side of town and they'll charge you a hefty fee once you're there. One guy saw Amy looking at a map and tried to scam her. "Wat Arun closed half day. You come with me... I .... show you....ah..." Then he just walked away. Five minutes later he came back and said "I show you temple... ah... eh..." then just turned around and went to sit under a tree. So hot even the scammers can't be bothered to scam properly.

Wat Arun from the opposite bank.

2 dollar ferry ride across the river to see the Temple of Dawn.

These statues reminded of some Chinese statues I've seen before. I guess there must have been some common ancestry to their art styles.

So many Buddhas...

The main spire represents Mount Meru, a mountain that exists at the center of all universes. It's covered in porcelain and seashells.

The main spire is 250 feet high. You can see the ladder leading up to the top. I'm sure they give the job of cleaning bird poo off the porcelain on the main spire to the new guy.

CAW

Each terrace of the spire represents a different level - the first, all worldly realms. the second where all desires are gratified. I don't know what the last terrace represents because we only got to where my desire to climb further was gratified, then we left.

Crazy steep on the way down. I felt like a baby who broke through the toddler fence on the stairs.

Not a lot of room for your shoes, but a lot of room to fall.

Porcelain on the Wat Arun spires.

The next day while Amy and Shef were at the conference I decided to see the Queen Saovabha Memorial Institute Snake Farm. This is where a lab has been established to produce snake antivenom. Basically, they round up a bunch of poisonous snakes, stick em in a box and milk them for all they're worth. Just like Independence Day. You catch them, study them, then use their own technology to blow up their spaceship.

I think this one was a king cobra. They have very large occipital scales. Even though he wouldn't look at the camera, the nice thing about these snakes was they were all fairly active and moving around. Not like the snakes at the Science Center who lie under a rock so you can't see them.

There wasn't a lot of information on the displays where the snakes were kept. I don't know what type of snake this is, but presumably they're all poisonous.

This guy's skin looked like a china bowl.

It's not the real Whitesnake, just a cover band.

Snake venom extraction! The main snake handler is on the left with his three assistants to the right. 

The first snake ready to be milked.

First they use this wooden ruler type device with a plastic shoe on the end of it to isolate the snake's head and pin it against the table.

Then they can grab it just distal to the head so it won't bite anybody.

The poison glass is prepared...

LET THE ENVENOMING BEGIN.

And for some reason, this snake didn't feel like deploying its fangs today. Next snake then...

squick

This snake didn't want to bite either. On to snake #3.

Finally some action.

It's sort of crazy how green/yellow the venom is. It even looks poisonous.

I wish I remembered more of the names... I think this may be a  flying snake but I could totally be wrong. It's venomous but only if you're a frog or other small animal.

Oriental rat snake. Eats rats whole. Also hyperactive. I'll post a video later showing how much he moved around. Looked like he was trying to get at the child standing next to me. Such a ratlike child...

There was a snake demonstration after the venom milking, but it wouldn't have happened for two and a half hours. I wasn't willing to wait that long in the heat. Needed to find somewhere to take a break. This ramen shop on the way home wasn't too bad.

I guess some things are universal.

After meeting up with Amy and Shef, we were due to see Huong and her boyfriend at the conference hotel for dinner. They had pretty nice facilites at their location, so we took some time to poke around the upper deck.

BTS Siam station traffic. They have really long lights here. Like in the order of 5 minutes +.

Food vendors gearing up for peak selling hours - night time.

The merchandise looked fresh everywhere I saw it. No running water though.

Still, virtually every cart I saw had some pretty brisk customer turnover.

Ultraman in a mall, for some reason.

27th floor on the way to meet Huong and her boyfriend in the Central World hotel.

Central World candy shop - pulling candy in front of yo face. I don't know if those kids ended up getting some or not. They were as content as children would have been in a confectionary purchasing establishment.

50th or so floor of the hotel

Somehow a gecko made it all the way up to the top of the tower.

Oh I didn't see you there. Don't mind me. Just sticking to the window on the 50th floor . Ordinary day in the life of a Bangkok gecko.

If I had a halo, it would have to be a square one.

Street nightlife picking up next to our digs. Despite how busy it is in the daytime, at night it's even more crowded.

The next day I was on my own again and I decided to buy some new shorts since mine were coming apart at the seams. I asked this tuktuk guy how much to get to the Pratunam market and he quoted me 3 dollars. Pratunam was at least 20 minutes away.

Rode for about 20 minutes in really slow traffic.

Then got off and he drove away before I realized he took me to Platinum mall, which was pretty much less than 100 meters away, instead of Pratunam which is substantially farther. Ah well. I'm sure I'm not the only one to get hosed by a tuk tuk driver.

Congee for breakfast. Would take this over eggs and bacon any day.

Crunchy crepe desserts sold in stalls all over town.

I never realized where we ate breakfast most days because it was so cheap and good was actually known everywhere for being cheap and good. The area looks kind of run down but I suppose that's why it's cheap.

wut the

I didn't make it to Pratunam market but the three of us headed out on Saturday to the Chatuchak market, the biggest weekend market. It is IMMENSE. We spent half our time exploring probably 10% of the total area, and half our time trying to figure out how to get back to where we started. Wikipedia says it covers 35 acres, and I don't doubt it.

Figuring out the BTS train system.

Never a shortage of food at a market.

Typical stall in Chatuchak. Everyone loves the king. Disparaging the king, either through spoken word or through action is a crime. They also play the king's anthem and show a montage of the king's photo ops before movies. Everybody has to stand like it's the opening ceremonies of a baseball game. Very different.

I tried to buy from this guy but all he did was show me his fangs and turn invisible. Couldn't bargain to save his life.

Taser for sale. "Honey, I'm just going to pop over to the weekend market. Do you want anything" " Taser. We're all out of taser." "Oh yeah, I'll pick one up for you." I thought it was fake until the lady came over and buzzed it for me. It's definitely real. Zap crackle pop.

Amy dress shopping. "I'm looking for something my husband will like"

"It's not for me."

"It's for him."

There are a lot of people wearing t-shirts that I don't think they understand. I saw a guy who was wearing a shirt that proclaimed that he was addicted to "roosters". I don't think he actually had a "rooster" addiction, and even if he did I don't think he'd want the world at large to know. Judging from the number of people who spoke no English, I wouldn't be surprised if people wore these without any idea of what they mean.

Getting a Thai massage. I'm here because it was air conditioned and the temperature was too damn high.

I was wearing a golf shirt but as soon as I got to the market I looked for something without sleeves to buy. Couldn't take it anymore.

Got here on the shop's opening day. I think it was 8 dollars for an hour of massage? Not a bad deal.

The girls seemed to be getting a pretty good massage. I don't know if my masseuse was trying to hurt me or not but she had really strong fingers. And she used a stick to really dig into the feet. Nobody else used a stick. Why do I get the stick?

It was just nice to get out of the heat for an hour.

They definitely do sell butterfly knives here, right next to the machetes, katanas, and for some reason a  softball bat. I take it the vendor doesn't intend for it to be used in softball.

Pithy.

From the pet section. The whole market is divvied up into different districts and departments.

Chef Tony in charge of the paella.

Creepy good luck cat window.

One of the things I was looking forward to the most about BK was seeing some Muay Thai. The biggest stadium was just down the road from our hotel so on our last day there we headed over to see a few bouts. I gotta say, I was not disappointed.

Couldn't find a way above the ropes, so unfortunately they're in pretty much every shot I took. Stupid autofocus kept  putting the fight out of focus too, choosing instead to bring out the detail in the rope manufacturer's label. Frig.

Nice foot punch. 

I think these guys weighed around 120lbs each. So basically one of me if you take away all the churros and fat pads.

I cringed every time I saw them check a kick with their shin. I don't see how taking a shin on the shin helps anybody.  It's like saying I really don't want to be punched in the gut so I'll just block it with my face.

I read somewhere that vaseline application in Muay Thai was illegal but I saw both corners putting it on pretty liberally so I suppose it's not a big deal.

The next few rounds took place at close range and involved a lot of knees and jockeying for clinch position.

From this point on it was all clinch. Blue trunks looked like he was going to lose if it came to a decision.

Textbook kick checking.

No real KO yet, just some illegal judo sweeps.

Good clinch position, ready for a knee to the face.

I glanced down for a split second to check if my manual focus was working or not and I missed the KO. Red trunks blasted the guy in the chest with a front kick and he went down hard in the third round and didn't get back up. Unfortunately I didn't get it on photo or video. 

Way Khru Ram Muay is a ritual performed by each fighter before competing. It often is individualized and can give hints about where and who they have trained with.

For the most part, each fighter seems to follow the same basic outline which includes walking around the ring and bowing.

Last minute prepping.

ROUND ONE. FIGHT.

It's like watching two mini Sagats from Street Fighter go at it, except fewer fireballs and eyepatches.

Well executed block.

Not so well executed weave.

Most of the times a fighter fell to the mat were because of tripping and slipping more than actual knockdowns.

This pair seemed to prefer clinching after the first round. The crowd was CRAZY. Every time one of them landed a knee their corner would erupt in a "OY" cheer. I'll post a video on it later. Really gets you into the fight.

Solid kick to the ribs.

This one in the blue trunks managed to kick so high his leg went over the ropes and he was sort of stuck there for a second. They're flexible like ballet dancers. In a ballet of brutality.

Getting attended to by the cutman.

That's right ladies. Try to restrain yourselves. Please. (Now that I think about it, I wonder if that excludes women from boxing at all if they're not allowed to touch the canvas.)

All the necessities to fight right here. A wheelchair, a stool to sit on, your water supply, a big  steel tray to catch your drippings, and a spit/vomit funnel.

And I'm not 100% about this, but it looks a lot like a jock and some sort of sacred jock holder.

2nd row seats. We couldn't get any bleacher seats because they don't allow pictures in that area. Apparently it's where all the gambling takes place, which is illegal in Thailand. Don't trust themselves not to show up splashed all over someone's Pinterest page engaged in illicit conduct .

More Way Khru Ram Muay

Spitting water on each arm and leg.

Hard lick to the thigh. You could hear the sound of the kick impacts echo.

Getting stretched and massaged between rounds

It was hot just sitting in the stadium, let alone getting boxed for 4 rounds. I don't have any idea how they managed up there.

In one sense, you're both winners. In another, more real, sense, red trunks is the winner. Mainly because he beat you, the loser.

This was the best round of the night. Unlike the other rounds, this one had none of the usual clinch and knee business. Most of the time was spent lobbing high risk kicks and punches at each other from mid range with good energy until the bell. Red trunks kept his hands low, inviting kicks to the face throughout the round but managed to slip and effectively counter virtually all of them.

Another slip. Any close and he'd have toenails in his eyelashes.

A fresh fighter awaits his turn in the ring.

Last day in Thailand. Nothing much left to do in the city except a last minute walk through the mall.

Some white guy owning a Thai singing competition in Central World.

Double swiss cheese gelato! It had real cheese in a small dice in it. Surprisingly palatable! (the brown stuff is chocolate... insurance in case cheese was gross and needed dilution)

Few videos to follow next post.