The days are passing...only 9 more sleeps until I get on that plane!
This week I spent with the Palliative Care group, as I can help ease the burden while Jenny Crane (one of the docs) is away, and I still felt I had more I could get out of it. A highlight was sitting in with Dr. Melissa Eastgate, an oncologist who comes to Bundaberg once a month from Brisbane. I also got to connect with a number of my palliative care patients again. Over the last three weeks, I have walked with ten people who finished their journey during my time there. Very special.
On Wednesday, after rounds, I jumped in my car and ran back to Brisbane (~4.5 hr drive) to view a potential place for Rob and myself once we get back in January. I spent the night in my old flat, and was up and on the road at 3:30 am to make it back in time for Thursday's rounds. Ugh. Not recommended.
I also went to Mon Repos turtle rookery on Saturday night, and watched a gigantic loggerhead turtle lay 155 eggs. Also pretty cool. The pictures are on my facebook page.
This next week will be spent in the emergency department. I'm hoping for some interesting cases, and it would be nice to suture someone up, or start puncturing people (for therapeutic reasons only). I'll let you know!
Eh-team Menu
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16 November 2009
08 November 2009
Elective Week Two
Everyone with us last Friday was still here on Monday. Plus some new admits. So I am kept hopping. Dr. Crane has gone to Ipswich, and Dr. Chapman can only be on 12 hours per week. This means I look in on all the patients that he cannot get to in his 2 1/2 hours every morning. As such I am learning lots. We always conference on everybody, so it's not like I'm high and dry. Tuesday we went to GinGin and Mount Perry (1 hr and 1 1/2 hours away from Bundaberg, respectively)to do home visits. I went with Dr. Whan, a Palliative Specialist who does outreach from Brisbane, and Carolyn a clinical nurse. I have his contact details, and so will be harassing him next year. He is fine with that, as he informs me there is (of course!) a shortage in Palliative Care specialists.
My 1st year colleagues in Emerg and Paeds unfortunately got to share an experience. There was a highway crash near Childers, leaving a mother dead, and 2 yr old in critical, and 4 yr old less seriously injured. So they are decompressing from that. The helicopter pictures I got were of the chopper leaving for Brisbane with the 2 yr old and his father, who was not in the vehicle at the time. I feel so bad for that poor man right now.... (I am not divulging anything more than was already reported in the local paper, and thus I am not breaching confidentiality, just in case anyone was concerned).
Wednesday afternoon I began to feel very tired. So much so that when I was give two hours off during their admin meeting, I chose to go home and nap, returning to check up on the last of my patients. Thursday morning I was full blown sick. So Thursday and Friday were spent recovering, and staying away from the immunocompromised cancer and palliative patients. It is not advisable to hasten the inevitable, especially by being too boneheaded to know when to stay home!
My 1st year colleagues in Emerg and Paeds unfortunately got to share an experience. There was a highway crash near Childers, leaving a mother dead, and 2 yr old in critical, and 4 yr old less seriously injured. So they are decompressing from that. The helicopter pictures I got were of the chopper leaving for Brisbane with the 2 yr old and his father, who was not in the vehicle at the time. I feel so bad for that poor man right now.... (I am not divulging anything more than was already reported in the local paper, and thus I am not breaching confidentiality, just in case anyone was concerned).
Wednesday afternoon I began to feel very tired. So much so that when I was give two hours off during their admin meeting, I chose to go home and nap, returning to check up on the last of my patients. Thursday morning I was full blown sick. So Thursday and Friday were spent recovering, and staying away from the immunocompromised cancer and palliative patients. It is not advisable to hasten the inevitable, especially by being too boneheaded to know when to stay home!
05 November 2009
Updated website
I've started a update to the website. You can see the new look at www.eh-team.net. Enjoy.
My life is just continuing on as normal. I'm now living at our friend Barbra's house. The place I was at only had a single bed which wouldn't work well when Barb gets here. BTW, Barb is now less than three weeks away.
It's almost midnight here, so I really should be going to bed. 'Night all folks
My life is just continuing on as normal. I'm now living at our friend Barbra's house. The place I was at only had a single bed which wouldn't work well when Barb gets here. BTW, Barb is now less than three weeks away.
It's almost midnight here, so I really should be going to bed. 'Night all folks
02 November 2009
Elective Week One
I have now finished my first week at Bundaberg hospital. I am under Drs. Jenny Crane and John Chapman. We have had what they describe as a heavier than normal week. We've had a few departures, and a lot of getting to know some great people. These Docs also cover the oncology ward, so that has been thrown in serendipitously. I have some experience with my work at the Breast Centre on the diagnosis side of cancer. This is more the management side. Most patients have already seen an oncologist in Brisbane, and are having the treatments in Bundy, as it is closer to their homes. I have been impressed by the staff here, as they are all very generous with their time and willingness to explain things. I also keep a little notebook by my side at all times, and write down unfamiliar things to look up later. So my evenings are spent in AccessMedicine and MDConsult (the Dr.'s versions of Wikipedia). Thankfully the rate of trying to push things into my brain has slowed, and instead I am getting practice actually examining patients and taking histories. It is very gratifying when my observations are taken seriously during team meetings. I might actually end up GOOD at this!!!
Then again, 2 weeks in ED are coming up. Time to prepare to be wrong a lot....
This morning, I woke up at 3:30, which is usually when my bladder pokes me awake. However, I decided to stay up and go watch the sunrise over the ocean. It was beautiful, and I had the beach to myself. I left at 5:45, and headed back into town for the Shalom Market, which runs every Sunday at 6 am- noon. After picking up some fresh bananas and mangoes and just enjoying the energy of it, I drove back to my room and went back to bed. What a great way to spend a morning!
Then again, 2 weeks in ED are coming up. Time to prepare to be wrong a lot....
This morning, I woke up at 3:30, which is usually when my bladder pokes me awake. However, I decided to stay up and go watch the sunrise over the ocean. It was beautiful, and I had the beach to myself. I left at 5:45, and headed back into town for the Shalom Market, which runs every Sunday at 6 am- noon. After picking up some fresh bananas and mangoes and just enjoying the energy of it, I drove back to my room and went back to bed. What a great way to spend a morning!
28 October 2009
Queensland Ambulance and Boo-Ya! Boots
The past few weeks have been a whirlwind for me, and I haven't logged it, so this is a long post. The first adventure was riding with the Queensland Ambulance Service on a Friday night. Since our territory was downtown and the Valley (think Whyte Ave in Edmonton), we saw an awful lot of intoxicated/drugged people, and lots of vomit. Only one broken ankle, also brought on by inebriation. It was a busy night, and the attendant I was with allowed me to do blood sugars, blood pressures and ECG leads. 
I also allowed myself to fulfill a desire of 19 years, and bought myself knee high Doc Martens black boots. They are fantastic, and I always feel a little wicked when I wear them. They seem to have broken me in, starting with a blister that covered most of one heel. Now they are super comfy, and I love them as much as a woman can love a pair of boots (which I’ve heard is a lot)
The exam preparation was a crazy week of stuffing my head full of stuff. Lots of caffeine and chocolate went into it. And a little wailing and gnashing of teeth. The exam itself was spread over two days, and was mentally exhausting. After it ended, I gave myself the best present possible, and had an hour long massage. Heaven! Then packing up began. I am putting all my things in storage over the Christmas break, and Rob and I will find a new place to live in January.
I am now doing my elective placement in Bundaberg for 4 weeks. I start off with two weeks of Palliative Care, and the 2 weeks of Emergency. I drove the 4 hours north of Brisbane on Saturday, and took Apollyon with me, as I found a place that would let me keep her. She was distressed to be in the car at first, but then found her favorite spot was on my lap, co-piloting. So cute. My first day on the wards was definitely interesting: psychosis, uncontrolled cancer pain, dysfunctional family dynamics and Cheyne- Stokes breathing. I was paired up with a Dr. John Chapman, and we had what he would call a hectic day. We had 4 admissions from home, via the ER. They were all terminal cancer patients having breakthrough pain that was not being controlled, and 1 had difficulty breathing because the cancer in his lungs were squeezing his windpipe shut. One lady thought she was in India and that people were trying to poison her and begged us to take her to the hospital....
We are expecting a few departures this week. I have learned an awful lot about morphine and all its opioid equivalent friends. And that terminal cancer pain requires a LOT of morphine. For example, one patient is getting 300 mg of morphine per day, plus Fentanyl patches worth 450 morphine mg equivalents. The average ER visit type trauma pain would get you 2.5 mg of morphine. And unfortunately, when they land in ER, that's ALL THEY GET. Can you imagine the suffering if you were at those levels and then bumped down like that??? Unfortunately, these palliative patients are sometimes dismissed as drug seekers, or worse, subjected to rafts of tests and scans and probes to heroically find out the problem and "fix" them. The problem is they are dying, their bodies are changing in preparation, and it's just not fixable. The palliative care area has evolved to help make the last months, weeks and days as comfortable and the least distressing for the patient as possible. That does not include stuffing them full of IV fluid which ends up swelling their legs and bellies (i.e. not in their blood vessels), and subjecting them to painful and invasive tests that will not change the course of their disease or its management. So we spent a fair amount of time in ER rescuing patients from earnest doctors.
The end of the first day was good, satisfying, but I was exhausted. I went home at 7pm, put on my jammies and went to bed. The second day was also a lot of running around, but I don't feel nearly as tired. I guess it's just the transition from sitting on my butt studying all day to actively seeing patients. I am LOVING every minute of finally getting to interact with real people!!!
I also allowed myself to fulfill a desire of 19 years, and bought myself knee high Doc Martens black boots. They are fantastic, and I always feel a little wicked when I wear them. They seem to have broken me in, starting with a blister that covered most of one heel. Now they are super comfy, and I love them as much as a woman can love a pair of boots (which I’ve heard is a lot)
The exam preparation was a crazy week of stuffing my head full of stuff. Lots of caffeine and chocolate went into it. And a little wailing and gnashing of teeth. The exam itself was spread over two days, and was mentally exhausting. After it ended, I gave myself the best present possible, and had an hour long massage. Heaven! Then packing up began. I am putting all my things in storage over the Christmas break, and Rob and I will find a new place to live in January.
I am now doing my elective placement in Bundaberg for 4 weeks. I start off with two weeks of Palliative Care, and the 2 weeks of Emergency. I drove the 4 hours north of Brisbane on Saturday, and took Apollyon with me, as I found a place that would let me keep her. She was distressed to be in the car at first, but then found her favorite spot was on my lap, co-piloting. So cute. My first day on the wards was definitely interesting: psychosis, uncontrolled cancer pain, dysfunctional family dynamics and Cheyne- Stokes breathing. I was paired up with a Dr. John Chapman, and we had what he would call a hectic day. We had 4 admissions from home, via the ER. They were all terminal cancer patients having breakthrough pain that was not being controlled, and 1 had difficulty breathing because the cancer in his lungs were squeezing his windpipe shut. One lady thought she was in India and that people were trying to poison her and begged us to take her to the hospital....
We are expecting a few departures this week. I have learned an awful lot about morphine and all its opioid equivalent friends. And that terminal cancer pain requires a LOT of morphine. For example, one patient is getting 300 mg of morphine per day, plus Fentanyl patches worth 450 morphine mg equivalents. The average ER visit type trauma pain would get you 2.5 mg of morphine. And unfortunately, when they land in ER, that's ALL THEY GET. Can you imagine the suffering if you were at those levels and then bumped down like that??? Unfortunately, these palliative patients are sometimes dismissed as drug seekers, or worse, subjected to rafts of tests and scans and probes to heroically find out the problem and "fix" them. The problem is they are dying, their bodies are changing in preparation, and it's just not fixable. The palliative care area has evolved to help make the last months, weeks and days as comfortable and the least distressing for the patient as possible. That does not include stuffing them full of IV fluid which ends up swelling their legs and bellies (i.e. not in their blood vessels), and subjecting them to painful and invasive tests that will not change the course of their disease or its management. So we spent a fair amount of time in ER rescuing patients from earnest doctors.
The end of the first day was good, satisfying, but I was exhausted. I went home at 7pm, put on my jammies and went to bed. The second day was also a lot of running around, but I don't feel nearly as tired. I guess it's just the transition from sitting on my butt studying all day to actively seeing patients. I am LOVING every minute of finally getting to interact with real people!!!
16 October 2009
Car freedom
For the first time since 1998, we don't have a car payment. As of Sept 22, the Matrix is paid for. And for the first time ever, I had a car warranty expire on time rather than distance. The 5yr/200,000km warranty expired at 5 years and 198,000km. Last Saturday the Matrix did roll over to 200,000km or 0.2 gigameters on the way to visiting Mom at the bird sale in Innisfail.
The bird sale was cold this year, even colder than usual. The sale was slow too, so Mom packed up early and spent more time visiting her friends Helen & Paul.
The bird sale was cold this year, even colder than usual. The sale was slow too, so Mom packed up early and spent more time visiting her friends Helen & Paul.
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