Godbye Tassie, Hello Tropics

We appear to have left Tassie just in time and Tassie appears to be largely closed for the present by the volcanic ash from the Peruvian vocano - no flights in or out for nearly a week. That might well have resulted in my doing serious bodily harm. To myself or others.

But, we made it out successfully just ahead of the cloud and off to the tropical wonderland of Cairns, Queensland - well inside the tropics. A small version of Cancun in many ways: large high rise hotels and plenty of stuff for the rich and super-rich. Gotta travel a way for the beaches, though. And, if rumor is correct, about half the hotel rooms are "backpacker" hotels.

The backpacker label appears to be a rather specific lifestyle in OZ - even in Launceston, there were lots of backpacker hotels. Cairns is full of them - with many subspecialties: women only, hostels, cheap hotels, etc. They're mostly back from the beach a bit and in a district of cheap restaurants (though some were quite good), and plenty of alternate lifestyle shops. The backpackers apparently live the lifestyle long enough that many of them drift from job to job - and right now, Queensland is short on temporary jobs such as banana picking (trashed by the cyclone), cane cutting (mechanized), and tourism (down by the global economy, and by the extraordinarily strong Aussie dollar).

We spent 4 days on a small cruise boat (18 folks on a boat that normally holds 50, 1 Kiwi, 2 brits, and us 2 Yanks) out on the Great Barrier Reef. Loafing, and getting in a couple hours of snorkeling each day. Pretty stuff and enjoyable. The highlight seemed to be the giant clams, which are not only large, but quite colorful. Disappointed to not see any Octopus. But, the super highlight was having a whale (not very big - maybe 20 feet, Minke) swim by while snorkeling. I've seen (and petted) whales close up from my kayak, but seeing one under water was quite special.

As much fun as anything for me, was hanging out on the bridge (open bridge policy). Got to know the captain a bit and learned a bit about the navigation and weather issues. Quite fun was watching the "trainee", and the first mate, and the captain - and other sailing staff - interacting over the trainee issues of the boat: very much akin to medical residency training. The trainee is filling out logs of stuff that he's done - and the mate's evaluation forms of his performance, and picking the brains of the mate, and practicing tying knots and having the mate tear them apart (the knots, not the trainees), while the mate did all the formal calculations of the navigation and filled out the paperwork, and the captain sat somewhat aloof and shmoozed with the passengers (me, mostly), and occasionally critiqued, corrected, and taught the underlings. Cool electronics with depth meters, radars, GPS, and lots of different ways of displaying the data on a bunch of different screens. Great fun. I think I could sail it now.

Got a chance to get out mountain biking a couple days, including one day riding the system of trails used for the 1996 world championships. The hardest bit we just walked to and looked at (and when I later looked at a video from the world champs, nobody successfully rode it - though I heard that one guy made it down successfully on 1 of the 6 laps). A number of other sections that I didn't ride, though I think with some work I might get down them.

Spent one day hiking, and one day on a guided tour in the rain forest - got to see a cassowary on our unguided hike - quite a treat and rather rare. The guided hike was kinda a quirky guy that has his own private nature preserve and feeds the animals and birds a lot, so they get quite close (actually one bird tried to grab some food from inside my mouth - I think that's pretty close). Pretty knowledgeable and entertaining.

Now we're in Sydney doing city stuff - including a symphony orchestra concert. More later if anything interesting happens.

What happened?

Should I cancel my flights? Stop in Utah and wait for Colorado to re-open?

(Colorado is (was) a large clothing retailer in OZ)

University of Tasmania Medical School

Today was my last shift - and I didn't do too much work: many of the students, interns, residents, and registrar grabbed me for performance evaluations. Not my favorite thing - i'm not good at evaluating folks' strengths and weaknesses and I'm terrible at being critical.

But, I talked with some of the students and learned a bit about the med school: 5 year school, straight out of secondary education for most. 1st 3 years are all preclinical and in Hobart at the main University Campus. Then 2 years of clinical rotations spread out to Burnie (small hospital in a city of under 30,000), Launceston, and Hobart. By reputation: Burnie has good teaching programs but a small hospital with limited patients. Living is cheap, so those on low budgets like going there. Hobart - good to stay near family, big hospital with all the specialties and lots of patient material, but poor teaching. YOYO approach - not even much in the line of lectures, supposedly. And here's the shocker: Launceston is the place to go for good teaching: plenty of lectures and programs, and REgistrars and consultants who are willing to sit down and go through patient presentations. Hmmmm!

Got home from work, and suddenly my phone rang with the ER number on it! AAAGHHHH - did I forget that I was on call? Was there a disaster and they needed more help? Turns out that some of the nurses didn't realize that I had just finished my last shift - and called - at midnight, to say goodby. Good on ya, mates.

Talked a bit with one of the Reg's about medical care in India - his home. Public hospitals and care is apparently abysmal, crowded, overworked, poor quality. And, an impenetrable barrier between private and public. The big companies all provide insurance for the employees, and the private hospitals are by his account, comparable to the more developed world - big, clean, well equipped with all the latest - and partly supported by medical tourism including from the US. His mother had a syncopal episode (fainted) last month and got a CT, MRI, and echocardiogram for $600 and got her permanent pacemaker for $6000. I believe that I could see a syncope patient at the University and the cost of cab fair to DIA, plus round trip flights, plus all that stuff would be about 1/3 of the cost to get it done at the U.

OK, probably no more medical stuff. Off to the Great Barrier Reef and mountain biking in Queensland.

A Snog in the Fog for the Blog

Jean & I took a drive up to Ben Lomond - Tasmania's ski area. It was thick fog (thus the Snog in the Fog last picture). We hiked up the ski hill - measured it at nearly 600 feet of vertical. Beautiful tundra - though we could only see a few feet of it at a time. Wallabies all over the place - interesting animal to have on a ski slope.

Ben Lomond's Terrain Park. Really, this was the only feature that we could find.

Hard to tell in the picture, but the tuft in the middle of the moss is about 10 feet across.
The Snog in the Fog. One of the finest self portraits to date.

Finally some time off

Jean's been here a few weeks now. We've gotten in a little riding. Nobody in Tassie rents road bikes, so she's been renting mountain bikes and cruisers and when we ride together I use the cruiser and she uses the 'cross bike with road tires - we end up about the same speed.

We've been to nature parks to see wallabies and 'roos, and wombats. Onto the beach at night to see the "little penguins" - cute little guys about a foot high. Rode out along the Tamar River - quite a beautiful rolling ride. Stopped on one ride to watch a little "footy" - may be one of the great games in the world: you can run, kick, throw, tackle, dribble - all on a field the size of Rhode Island.

Post dental bleeding

Despite the overloads, this place does have interesting stuff to do.

Yesterday a local dentist pulled an upper wisdom tooth and somehow managed to get into major arterial bleeding and brought the guy to the ER. We could temporarily control it with direct pressure, but any time the guy opened his mouth it was a major gusher. And, the guy was a "gagger" with a big tongue and limited mouth opening.Max/Fax was planning on taking him to surgery to ligate his greater palatine artery - but they were tied up for many hours in a big radical neck. So, what the hell, why not inject a little epinephrine into the palatine foramen like we "try" to do in palatine nerve blocks. So, with horrible visibility between the anatomy and blood all over the place, I used a needle like a harpoon in the general direction of the back end of the hard palate and squirted in a bunch of marcaine with epinephrine. (Not sure, might have missed and squirted it into the carotid or brainstem or something, for all I could tell.) Much to my surprise it either worked, or was performed just at about the time that the bleeding stopped spontaneously.

And to round out the day a posterior shoulder dislocation (the only one I can remember seeing that wasn't due to a seizure), a grapefruit size fungating cancer on a guy's hand (his GP had been trying various ointments on it for a ear), etc. I've cardioverted more folks in the last 3 months than I have in the last 5 years at University, and probably about 2 years worth at Boulder. And more profound bradycardias than I've ever seen.

Couple days a ago had a distal radius reduction in fastrack, so ketofol - no monitoring, no suction, etc, etc. Thankfully that went well and had been done by the Registrar before I heard about it.

Crushing workloads

It's been a while.

One of the great difficulties of an ER like Lonnie is that with the vast majority of the staffing being provided by fly-in-fly out Docs, when something happens to affect staffing there is no slack in the system. So, an illness in either a consultant or a Registrar leaves one with no backup (the administrative doctors seem to have no interest in helping with clinical coverage. It's quite entertaining to see the medical director wandering through the department with a bunch of "suits" chatting, bulshitting, and checking the dust in the air ducts - while we're short one consultant and two registrars and there are twenty in the waiting room.) 3 evenings ago, the charge nurse came to me in near tears - just didn't know what to do. We had no beds, no place to put another patient, and were at a complete standstill - about 20 waiting , with a few ill (unwell in Australian) but mostly minor complaints. Our only hope was that many would give up and go home - which was what ultimately happened.

As best I can tell, the underlying problem is one of this pattern (apparently widespread throughout Australia, except in the largest cities - all 7 of them) of fly-in-fly-out. The Docs apparently like it (the guys tell me that they make much more in their locum jobs than they do in their permanent jobs). But, it leaves most hospitals with nobody to keep pushing to get the system to work, and of course, no way to take up slack in case of an emergency - whether a crunch situation, or a staff illness.

Anyway, because of all that I've been working far too many hours and under far too much pressure. And, have had no time nor energy to keep up the blog.