After a prolonged absence, we now have access to the internet after A and E hours meant that Ian was able to co-ordinate with the internet man between 9-5. Ironically, I now have most of 9-5 to mess about on the internet myself, albeit in a hospital setting. I am a Respiratory Registrar for the week and have very little to do. They have plenty doctors and interns here . What they do from 8-5pm, we would fit into 9-11am in Dumfries, because of the time pressures there. Despite being a tertiary referral centre (PCI and a 24 hour cath lab on site, so everyone gets and angio and no thrombolysis here!) there wards aren't as busy as back home, mainly as A and E is so much better here and takes a lot of patients into the 48 hour ward it has - so no overdoses, ACIS with the morning troponins etc. The Ward Reg. sees the patients (about 8 today) and I see any A and E referrals and ward consults. I also do the clinic (2 patients booked in so far!) and Exercise Tests - 1 so far to do tomorrow. I would like to do more, partly because I'm really bored and also because the clinical work is stuff I've done loads of times in Dumfries, and I'd like to show the Consultants I'm competent so that when it gets to the 2am Resus Call, we have a good rapport.
It's not all relaxation however - I got to review a lady in ICU yesterday regarding wheeze. My Consultant (who is clinically excellent) is unavailable so I can't discuss it with him. I wouldn't normally discuss wheeze with anyone back home but people here seem to like to be involved in everything and I think I overstepped the mark by starting an antihypertensive on my own last week. So I have been free since 8.40am. I went up to the ward but the Ward Reg. only has a few patients and she has 2 interns and a med student to help her with them so there's nothing to do there. At least Ian is working 8-6 today so I'm waiting for him to have a coffee break or lunch.
Still, at least this is better than Geris. Patients here only get admitted to Geris if there is no other possible place for them to go - so that normally means people who need physio or social admissions and people with unfixable fractures or Parkinson's Disease, or people with dementia. So ward rounds are really social rounds with the occasional bit of medicine thrown in. In terms of clinical practice, most of the Consultants seem to use the same guidelines as we do, which is a relief. In saying that, I have seen antibiotic and renal practices which would enrage the respective Dumfries Consultants - such as the one where you don't treat a systolic of 170 in a diabetic with a previous CVA because of the risk of glomerular hypoperfusion, or treating a proven staph sepsis sensitive to flucloxacillin with 3 different antibiotics - presumably to make sure that the patient is depleted of their entire stock of bacteria, and not just the offending staph. I'm in Geris till January (the only speciality with 1 in 3 weekend on-call) then Haematology and Palliative Care for 3 months each.
It's very strange being at work and having nothing to do. In Dumfries I could have gone and helped with receiving or A and E or helped with someone else's ward round but here, there is much less work (most days involve a ward round of 15 patients, max and at least 1 intern to help out). Sadly I can't leave until 5pm in case someone wants a Resp. Reg review. Next week I go the local DGH so I'm hoping that will be a bit busier.
So, Canberra.
It took a bit of getting used to. When we first arrived, we were staying in the Hospital Accomodation. Our room was very bleak, just 2 beds and a sink. The corridor had a picture of an abbatoir featuring a distressed sheep outside our room. Plus, there wasn't enough room on the staff floor, so we ended up in the outpatient quarters. I imagine that most of those were patients who were in for chemo, as they had that characteristic pale and washed out look about them, plus they seemed to spend a lot of time in the bathroom. Either that, or they'd just had Picolax. We walked for about a mile without seeing anything but a bare wasteland, and finally came to Woden. Appropriately named, as it is indeed a den of woe, Woden consists mainly of a grey shopping centre and a used car yard.
Thankfully, we had a week before work began, and so we spent the next few days traipsing round the city, trying to find an apartment. The one which we found is in the centre, and is nice in a very modern kind of way - it's like living in IKEA (you'd like it, Mum). We have an open plan kitchen and living room and a bedroom, as well as a bathroom. There is a balcony, which we are growing herbs on as a substitute garden. There is also a small outdoor pool and gym for the complex. We've made it to the gym once, as in order to get to work, we have to get up at 6am to get the 2 buses there, and we get back at about 7pm, eat and go to sleep. Aside from the last couple of nights, where I've decided to live dangerously and wash my hair the night before, thus giving me an extra half hour in bed.
The wildlife is also quite cool - there are several flocks of Galahs around the hospital and we keep seeing Cockatoos and parrots flying around. We keep hoping that a galah will land on one of the power lines, so we can shout 'You flaming galah!' at it. There are also quite a few Kangaroos as you get further out, including one which has been slowly decomposing adjacent to the hospital for the past week. I've seen a few smaller spiders in the bushes, and one night, we saw a massive one the size of my palm outside, crawling along beside a building site and covered in dust. after reading that there is one species of spider which particularly loves bathrooms, I am now able to go in to one without checking every crevice for one, in case it runs out (some of them have excellent eyesight, apparently) and bites me. No snakes or scorpians yet!
The city is very open which is nice, and compared to built up places it is really nice. Being so dry though, the greenery is quite pale and there's a lot of yellow and brown and everything is really new and modern - completely differently to Scotland. Sydney was really nice as it had a lot of Victorian buildings. We had 4 nights there - I would totally recommend it. They have some gorgeous Botanical Gardens, including many trees which are filled with fruit bats, which appear to have an alarmingly large wingspan. The image of several hundred menacing-looking upside-down bats does not seem to be one which Sydney embraces, and they are looking for ways to get rid of the bats. Apparently, bats hates snakes (I never though I would have so much in common with a bat) and so they have put essence of snakes up the trees. The bats, however, remain impervious and are resolutely hanging on. We saw the bridge and opera house as well, and had a nice little ride on a ferry round the harbour. A man we met in a shop told us not to go to Bondi Beach - "I just love Manly'" he said to Ian, pointing us in the direction of Manly beach, but seeing as he was evidently gay, I wonder whether he meant to send us there or not. Either way, the tide was in and so were the sharks, so we sat on the 1m of sand we could find spare, and then went back to the ferry.
They also had a 3D cinema at the harbour, which was showing a 3D film about underwater life, narrated by (but sadly not featuring) Johnny Depp. We also went on a wine tasting with several other younger people, which was fun.
As I said, Canberra is really modern, but the 2 pages which it usually gets allocated in the guide books is a bit unfair. There is a great little village called Gold Creek village which again, takes ages to get to by bus, but you can spend the day there. It has a miniature village called Cockington Green (very British, chaps) featuring scaled-down models of 'typical' British buildings. Funny how they seem to have glossed over most of the UK except Devon and Braemar castle? Still, it settled our homesickness for greenery. There are loads of craft exhibitions there as well.
There is a really cool market on a Sunday, which ranges from crafts to food, so we've gone there for the past couple of weeks. There's also the war memorial to see, the Botanical Gardens, and the Telstra Tower, which is a large revolving tower, providing views of Canberra. Plus, there's a cinema nearby which admittedly only shows 5 films at a time, but after Dumfries, that's actually quite a lot! There's also the National Museum, National Gallery and a few other National places to see. We've arrived at a good time as Spring means Floriade, which is the Canberra Flower Festival, primarily dedicated to the tulip. This mainly involves lots of tulips planted around the lake. It's nice to see so many colours, but I do miss the variety of garden stuff - I think that's one of the biggest differences here in general. Hospital life differs too. Apart from the substantially decreased workload, if you work any later than you are supposed to, you can fill out a form and they pay you more. This goes against what we do back home, and I've not filled one out, as NHS indoctrination has so far prevented me from doing so. Yes, I have actually stayed late a couple of times, as I didn't do my own ward round much last week, but went on one with the other Reg, Michael. Michael is an angel. He is just the most wonderful guy ever. If I ever get sick here, I want Michael to be my doctor. Come to think of it, I want him to be my nurse too. He kindly took me around the hospital and on his ward round and a few consults, to get used to the new system. The 2 major differences, apart from the workload, are that all the drug names are different, (they don't have bendrofluazide or IV augmentin, to name 2) and that Consultants like to be involved in every aspect of patient care.
The title 'Registrar' is slightly different to back home. Here, they can be Registrars without passing their MRCP equivalent. Most of the Regs here haven't got it. Those that have got it, are called Advanced Trainees. They've put me on the normal Reg rota, which is fine by me - as long as I get my 6 months of Cancer Medicine to give me a chance to work back in Scotland with Ian, that's all I want. It's definitely better than being a Medical Student, which is what the Consultant whom I had last week thought I was, until the actual med student mentioned that I was a Reg - people are older here. It's lucky she did mention this, as when he had given Michael the grown-up stuff to do, and told me that I could do the Mini-Mental State Examination and Geriatric Depression Score, I had been biting my lip to stop myself from saying that I thought I was slightly more advanced and could probably handle something a little grittier.
I have loads of time to check out internet stuff, and am slightly cheered to see that doctors are fighting back against the implementation of MMC. Make sure you add your name to www.mmcdiscussion.org as the latest is that we will apply for a job in the area 'Scotland' and I really don't fancy being stuck in Shetland for 3 years while Ian gets Borders. From the petition, it seems like loads of other people have been forced to go to Oz as well. I'm seeing pages springing up to help doctors who are quitting make the transition into another career, which is sad. From the way things are going, it seems like a choice we're going to have to make - do we stay in Medicine and risk living away from our spouses and families, possibly in a speciality we don't even want, or do we settle for an alternative career, with one of those nice extras ike job security, geographical security, being able to live with one's husband...... Tell all your friends and colleagues to add their names too. Non-medics can add their name to the site as well on a seperate petition.
Well, Ian should be free for lunch soon, and I only have another 3 hours and 20 minutes. I'm getting really into JAMA though, and my guideline knowledge has never been so good.
