Medicine "oop North"

[M Clayton]

Long time no post etc etc.

Insert combination of words implying business/laziness/more exciting things to do... ness.

Long story short - off to Australia for my elective this afternoon.

Manchester -> Heathrow

Heathrow -> Singapore

Stretch legs.

Singapore -> Sydney (That's Australia!)

Sydney -> Gold Coast

Jet Lag.

I'll try and update this thing but I shalln't make any rash promises - do they even have the internet in the land down under?



See you all on Rolf's Cartoon Club... Next... Week.

[M Clayton]

In Singapore at the moment - Changi airport (shares its name with the prison apparently, although there don't seem to be any emaciated folk dressed in rags... no wait, there go the English tourists)

The 12 hour flight here was a nightmare - I was sanwiched between 2 large ladies at the back of the plane, near the toilets. It did get worse, however, when a baby spent most of the flight crying.

I am now sick to death of travelling and I've still got two flights (of four) left to do.

Wish me luck!

[M Clayton]

Now in Sydney where it's, somewhat surprisingly, cold and wet.

Just one more flight to go now, so I'm on the home straight, as it were.

Customs here look way more scary than back at home but, actually, I managed to get through without so much as a single question. Chuh, this wouldn't happen in the States...

What day is it?? :S

[M Clayton]

I’ve been here in Aus for a week now and the highlight of my week so far is probably watching “Deal Or No Deal” last night. To be honest though, without Noel and his acting skills, the tension just isn’t there; I found that I just wasn’t involved enough to care whether Sheila from Wollongong (or wherever) won the 250k or not. Right now, I’m being entertained by the classic indigenous Australian drama that is Fawlty Towers….

Not Noel...

Anyway, enough of that jazz. Australian TV is as bad as its counterparts worldwide, but that’s not why I’m here now is it?

I’ll try and bring this up to date but don’t blame me if I miss out important things, it’s been a busy week and I’m still not entirely over the whole jet lag thing. Actually, who would know when I have missed something out… ?

Reg Grundies!

Sorry, I’m quite easily distracted by the television. Apparently, Reg Grundies are underwear. Australian is such a poetic language, don’t you think?

Since arriving last Saturday, I’ve done a bit of allsorts. My first couple of days were, despite the best efforts of the relatives that I stayed with, spent in bed trying to overcome the nightmare of jet lag. It took a while to get over the fact that I’d lost a whole day somewhere. I left the UK on Thursday but didn’t arrive in Sydney until Saturday morning – where the hell did Friday go?!

Initially, Australia appeared to not be as awesome as I’d thought it would be. First off, it rains here. A lot. When I left Manchester last Thursday, it was 24 degrees with beautiful blue skies – ok, they would have been blue if it weren’t for the smog. That’s not the point. The point is that I’ve come all this bloody way to spend my summer being rained on! I could have had that in the UK. Australia is meant to be all sun-kissed coastline and deserty interior where the sun never sets. As it happens, winter here means that it gets dark at 5 o’clock and the weather oscillates between warm and bloody cold. I suppose this is what I get for making my elective decisions based on no real knowledge of the country.

So that’s the obligatory “Brit Abroad” discussion on the local weather out of the way.

I moved into my first set of accommodation on Monday (The Queen’s Birthday holiday. Did you know that? Probably not; you’re not an Australian). It was not a good move to have made. As a student, I’ve stayed in some fairly dreary places in my time but nothing I’ve ever encountered had prepared me for this dump. I think it’s fair to say that my encounter with said dump coloured my mood for the early part of the week and homesickness was a real issue. It would have been a bit easier to bear if it hadn’t been so bloody expensive but, as it happens, I didn’t stay there very long (Thank God!).

Welcome to New South Wales!

I started at the hospital on Tuesday morning and was fairly surprised to learn that it consists of just 6 wards (2 medical, 2 surgical, paeds and ICU) an Emergency Dept and a few small outpatient clinics. It really is a tiny hospital! I’d assumed that, being a DGH, it’d be a little bit bigger – on a par with Darlington or North Tees maybe. Despite its miniscule proportions, it’s a pretty nice place to be. The buildings are all decently decorated and fairly modern. More importantly, the staff are fantastic. Everyone’s really friendly and helpful. Interestingly, everyone except the doctors seems to work in casual clothes – I’m having massive difficulty trying to work out who does what! The only giveaway that someone is a staff member and not a patient is the rather swish electronic door entry swipe card thingy (yes, I am easily impressed). That, and the lack of IV lines and armband obviously.

The Hospital

My “firm” consists of me, an intern (F1/2 equivalent, I think), a registrar and the consultant. This is considered to be a large firm at our hospital - most of the others either lack students or interns. Indeed, the paeds dept is staffed entirely by consultants! Surprisingly, our firm is as busy here as it would be in the UK – we were on take on Wednesday and admitted 40 patients. Couple that workload with 7:30 am ward rounds and any idea of having a quiet elective flew out of the window fairly rapidly! On the one hand, that sucks but it will be useful to actually do some real medicine again. SSCs were fun but I've pretty much forgotten how to clerk patients in any meaningful way.

Hmm. I want to add more photos, so I'll split this entry in two - keep reading for more exciting adventures in Australia!

[M Clayton]

Continued....

Isn't that picture lovely? I took that one yesterday (or is it today for you guys, I know not) from the helipad of the hospital. Yes, a hospital of just 120 beds and 13 consultants has a helipad. Odd, no?

What else can I talk about?

Well, outside of the hospital, I've been exploring the local area and trying to find a company that will actually hire me a car. At 22, none of the big companies will touch me with a 6ft pole so I might have to (a) go to a dodgy local company who may possibly hire me a deathtrap or, a personal favourite at the minute, (b) purchase what has been lovingly been described as "an absolute bomb, mate" (this will certainly be a deathtrap) and dump it when I leave. We shall see what happens.

Today, I went for a wander up and down the bit of coast that sits close to the hospital. It rained and was windy, but it was occasionally sunny.

Look, a lighthouse!

That's the lighthouse/James Cook memorial on the top of the cliffs at Point Danger. Those of you with a memory longer than the time it takes to cook a micro pizza might know that James Cook is the mammoth hospital in Middlesbrough where I've spent a fair amount of time - I can't get away from things from home, can I?

Hmm, I'm running out of stuff to say now, although it is quarter to midnight, so I think I can be excused.

I'll end with a picture of me at the delightfully upmarket "Sanctuary Cove Marina" so that you know I'm not just sitting at home in Hull pretending to be in Australia.

[M Clayton]

Another week over and I'm just about settled into life in a rural Aussie hospital. I love it when the staff tell me how underequipped this place is - it's about big as a cottage hospital (ok, I exagerate, it has 120 beds) yet has 2 spiral CT scanners, a bigger emergency department than Hull Royal Infirmary and access to a choice of 3 different PET scanners within the local region. They don't know how good they've got it!

PET scanners reminds me of the cancer meeting that I happened to attend this time last week. Over a choice of ice cold beer, fine wine and mini pizzas, the senior clinicians discussed the grave prognoses of several patients with lung cancer. Only in Australia can you get away with having beer at a hospital meeting!

What else can I talk about? General medicine in itself isn't really that far removed from the experiences I've had in the UK so I probably won't bore you with the details of that at this stage (maybe later when I really have nothing else to talk about).

The weather! Of course, I am British after all.

Well, we've had a week of near constant torrential rain. Everyone out here is very sympathetic when I moan about it and they all assure me that it simply never does this usually. Hmm, that doesn't help me now does it?!

[M Clayton]

The last entry was cut a little short by a MET (Oz equivalent of a 2222) call, so forgive me for the generalised crappiness that you were left with. In my defence, it was a pretty exciting call to go to - especially in view of the fact that MET calls here are so often false alarms that the medical team usually send their most junior staff member to confirm it.

This one was a surgical patient, one day post lap chole, who had collapsed to the floor on her way to the toilet. When we arrived (we being the med reg and I) the lady was sprawled on the floor with a surgeon thumping her chest and a nurse trying to make a faulty monitor work. Within seconds, pretty much the entire hospital seemed to turn up and join in the mayhem.

My role in all of this was to act as human drip stand/pressure infusion pump (I squeezed the bag of saline) while other, more qualified, people got on with the busy work. Somewhat surprisingly, after just one shot of atropine, an output was restored and the patient woke up with a raging tachy - better that than asystole though eh? Once she'd been passed to the ICU bods, I went had a cup of tea.

And then I went home.

It's finally stopped raining here (hurrah!) and I took advantage of the sun by going out to Kirra Beach yesterday afternoon. I lounged around on the sand, drank coffee at a swanky beachside cafe and had a little paddle in the sea. It was positively balmy. I stopped short of trying my hand at surfing though since I didn't feel like embarrassing myself that much. The paddling was enough for one day!

Kirra Beach

Today's been a fairly quiet day at the coal face. We discharged all but two of our patients from Med 1 and started the day with just 7 over in Med 2. We've ended it one down since our paliative care patient passed away over lunch. I'm not sure if his family made it down here in time but it was pretty clear that today was going to be his last. I do hope they managed to see him one last time.

Other than that, it's been another day of chasing bloods and investigations without any real urgency.

Tomorrow, we're on take, so things might get a little bit busier...

[M Clayton]

Another weekend over and, to be honest, another weekend wasted.

I've spent two days lounging on the beach reading books that I've picked up at the second hand book shop. I've also been working on my t-shirt suntan and now sport some superbly golden arms with a well defined tan line somewhere around mid bicep. It's a similar story on my legs with the tan stopping just above the knee. I know, I know, some of you are getting rather hot under the collar at my description of leg, so I'll leave it there

I bought a PDA last week having spent nearly a fortnight agonising over the choice and whether or not I could really afford it. As it happened, I ended up buying one on a whim when I agreed to accompany the RMO to Surfer's Paradise to pick up her new laptop. Whilst there, we popped into the massive Pacific Fair mall so that she could buy makeup or fluffy kittens or whatever it is that women buy these days. I happened to have a couple of hundred dollars in travellers cheques and spotted an electronics shop. The next thing I knew, I was being asked whether I'd like to purchase an extended warranty/stylus pack/screen protector/kitchen sink to go with the new machine. Now that I've had a few days to play with it, I'm quite sure that I'll end up using it for checking drugs on the BNF and that's about it. It does look pretty nice though...

General medicine is still going well. Our firm is at the stage where we've discharged all but 2 of our patients and we're not on take again until Tuesday. Both the reg and RMO are absolutely certain that this is the calm before the storm and that our next weekend on take (this one coming) is going to be a total nightmare. I've conveniently chosen this coming weekend to go to Brisbane with my relatives and shalln't be around for the frivolities. Damn shame too.

Oooh, it's time to stop eating free biscuits and drinking free tea (I love the JMO lounge) and get home to watch Daddy Day Care! Yes! My life is awesome. :P

[M Clayton]

Just a quickie.

I certified my first death today - well, I did all the leg work and my RMO countersigned the certificate, but it's as good as. I have to say that I felt like a real numpty going through the motions of confirming the absence of life signs on the lady - she'd been in a fridge for half an hour so I really didn't expect to hear anything when I listened for heart/breath sounds. But I leapt poodle like through the flaming hoops and asked the corpse if she could hear me. Madness eh?

[M Clayton]

You call that a knife?

This is a knife.

Sorry, for a moment there I was posessed by the spirt of Crocodile Dundee. Actually, is it possible to be posessed by the spirit of a fictional film character who might or might not be dead? I wonder....

Anyway, enough of that nonsense, how are ya? (Standard Aussie greeting - of course, they don't expect an answer, but that doesn't stop me from replying with "I'm great thanks, and you?" like a numpty every time)

This week is my last in General Medicine and I have to say that I'll miss the place. Back home, I looked forward to my time in the Emergency Department the most but now I'm here, I don't think I'm going to enjoy it as much. For a start, there are going to be another 5 students there when I am - yes it's a busy department but I don't know if it's busy enough to support 6 of us at the same time. Also, every time I've been there to review/admit a patient, it's been absolute chaos with nobody seeming to have the time for anyone else. I don't recall my time at Hull Royal being nearly so fraught but perhaps it was easier for me since it was home. Who knows?

This weekend started off fairly badly. I stayed in the hospital til 10 o'clock on Friday evening since my team was on take this weekend and I felt bad about having chosen to stay at home instead of going in. In order to make myself feel better (and also to ensure a good grade for attendance) I stayed to help the overworked registrat with admissions. On arriving home, I found out that the plans I'd made to go bush walking on Saturday had been cancelled since the person I was going with had terrible flu. Bummer.

I briefly toyed with the idea of hiring a rentabomb and going for a drive up to Mount Warning but I realised that I don't have a map and wouldn't really want to die alone on a mountain (much better to die in a group) so I quickly shelved that idea. As it happened, the cancellation of my plans meant that I was able to carry on with the plans I'd made for Sunday but on Saturday instead. Luckily (?) the rugby tournament that I was due to go on duty at on the Sunday had been moved to the Saturday afternoon (Fate?)

That explains why I found myself in a field in Murwillumbah (awesome name for a town eh?) watching the Kyogle Turkeys receive a beating from the Murwillumbah Mustangs on Saturday afternoon. There was a bit of drama when one of the under 18 players got dropped on his head during a tackle and was found by the physio to have "a step" in his neck. Not good. We (we being Derrick, the aussie member, and myself) stabilised the guy on the ground - collar and blocks and waited for NSW Ambulance to get there and take over. They arrived and decided that it was too difficult to transfer by road ambulance and called in the helicopter!


Helicopter!!!

So that was a bit of fun.

Yesterday was spent shopping for stuff I don't need at Pacific Fair. A most enjoyable day.

Enough of this for now - it's tea time.