Actually the last day of the PGA. Not overly interested in sessions.
Went to Metropolitan Museum of Art. Some interesting stuff but a little disappointing. Not actually the sort of art that I am interested in.

Sculpture terrace was very cool. Was made even more enchanting by the fact that I was standing there taking in the sculptures and Central Park out the window beyond the terrace and all of a sudden it starts snowing.

I’ve been to NYC three times and this is the first time it’s snowed. Big fat snowflakes.

Sore feet by the time I’d traipsed around all of the museum. Walked to Times Square, was freezing cold so decided I wasn’t going to stand around in the TKTS line.

Went back to East Village. Booked a ticket to “In The Heights” the latest Tony Award winning musical. Ate dinner and wandered back uptown. By this time it’s well and truly snowing. The snow was pretty cool to start with – and then it melted on my jacket and things just got cold.

Musical was pretty good. I was sitting almost in the gods….but I guess that’s what you get for buying cheaparse tickets. Still, the music was quite catchy. There were a few earworms slithering around my head afterwards.

Day 5

A somewhat cold freezing cold day even if I do say so myself. Slept in (deliberately) and then wandered around the East Village. There was a funky cafe that I’d seen in my previous wanderings that I wanted to check out. I eventually found it on East 9th St – Mud. Cosy. Great ambience. Best coffee in New York in my opinion (given my limited exposure to to coffee shops in NYC). Delicious breakfast.

Feeling upbeat (and zinging) after two large, strong lattes, I went shopping in SoHo and then wandered uptown to MoMA. Ironically, when I was in NYC the first time, I declined to goto MoMA on the grounds it didn’t interest me…to the point of sitting outside whilst others went in and explored. This time, I would rate it as one of the highlights of my RTW trip. I spent all afternoon there and probably could have spent longer had it not been closing time. Quite a stimulating afternoon.

Subway back to the East Village. Wandered past a funky cafe called Karen’s on Astor. Quasi-organic I guess you could call it. Food there certainly hit the spot – more protein, less processed carbs (processed carbs seems to be the norm in the US).

Went to Equus at the Broadhurst Theatre. I had a seat in the on-stage seating.
I was suitably impressed. The stage had been done up such that it was like one of those old operating theatres…or forums….where there are two rows of seating above the centre, circular space where all the action happens. Artistically it was almost like gods observing silently and passing judgement.

The performance was a slightly different interpretation to the one I was in. It was quite effective although I would say, budgetry differences aside, our local Brisbane performance certainly stands up well against it.

Day 6

Up at a sparrow’s fart.

Bus to Boston. Slept most of the way. Free WiFi on the bus which was good to pass the time I was awake.

Met Xav at the station in Boston. We wandered around Boston and Cambridge – including visiting Harvard. Had a noteable cup of coffee in Harvard Square.

I stayed at the HI in Back Bay. Was rather unimpressed at the cleanliness. The room I was in honestly smelt like it hadn’t had any fresh air in years. There was layer upon layer of odours. The predominant smell was that of musty stale starchy bodily secretions. Was not particularly pleasant. Fortunately I was sleeping next to the window and in spite of the bitter cold, I was able to prop the window open a centimetre or two to allow at least a smidgeon of fresh air to permeate the thick and putrid atmosphere.

Day 7

Met Xav and his mate Leo – who lives in Boston and is doing funky Bioinformatics at MIT and an MPH at Harvard. Toured Harvard Med School and the hospital complex near by (House of God territory).

Had lunch in Chinatown. Very full. Just as well…

… went to South Station to catch bus back to NYC. As I entered station, it was just starting to snow. Bus was overbooked. About five people after me got a seat on bus. By the time the bus left the station we were in a blizzard with snow everywhere. Trip back to NYC was at a slow pace (~60km/hr) meaning a 4.5 hour trip became a 7.5 hour trip. To boot, free WiFi wasn’t working and toilet was overflowing. I read and finished Chocolat.

Bitterly cold when arrived in NYC. Amazingly beautiful with snow covering the city. Slippery.

Day 8

Again up at a sparrow’s fart.

NYSORA Regional Symposium – again at Marriott in Times Square.
Far more interesting and useful than the PGA. Learnt quite a bit.

Went wandering in the evening. Finally made it to Strand Books. Amazing. 18 miles of books. I could have spent days looking through the piles of new and used manuscripts. Made a few purchases.

Went to Mud for dinner.

Dropped into funky hat shop “The Village Scandal” which is nearby to where I’m staying and tried on a million different hats. Got a funky suede paperboy cap.

Day 9

Ultrasound guided regional anaesthesia workshop this morning. In spite of feeling a tad cross-eyed from staring at grainy US images on screens all morning I feel inspired and empowered to go forth and learn me some regional anaesthesia. Made me realise how much anatomy I don’t know though.

Afternoon wandering around town in and out of stores. Didn’t buy anything. Sun came out and shone on the icy streets in the afternoon. Quite picture-sque with the steam rising out of the subway vents and the reflections off the ice and the buildings in shadow.

Took subway to JFK. Far quicker option than Super Shuttle me thinks. Took only about an hour from the East Village to JFK as opposed to the two-and-a-half it took last time.

Nothing worth buying in duty free.

Discovered a tasty beer – Brooklyn Brown Ale – in the Admiral’s club (American Airlines equivalent of the QANTAS Club).

Flight to London delayed. Was due to leave at 2135. Now 2300hrs with a departure time predicted at 0020hrs.

C’est la vie.

NYC Day 2
Slept in. Oh well. Interesting sessions in afternoon.
Stood in TKTS line and got a ticket to Spring Awakening at the Eugene O’Neill Theater.
Not a decent cup of coffee in sight all day. Sugar overload from Starbucks (cringe) hot chocolates. Spring Awakening was a pretty good show I’d have to say. I was impressed with many aspects including the staging, lighting and set. Very effective. Some of the actors seemed to be losing their voices but oh well.

NYC Day 3
Fark. Slept in. Missed TOE workshop. Oops. Oh well. Just annoyed because I could have spent the money on other things. Got up in time to have bagel/muffin/cornflakes (free) breakfast at hostel. Flaked out on bed again after feeling like ratshit. Slept. Through several alarms. Managed to stumble uptown to conference in afternoon. Worked out the reason I was feeling so ratshit was the processed high carb high GI diet that seems to be the norm here. Sugar highs followed by sugar lows. Ate. Felt better. Attended afternoon sessions of conference. Some interesting topics that make me wonder about the future of anaesthetics. Attended a lecture on electronics in anesthesiology put on by one of the equipment companies….supposedly a free dinner…..pretty lacklustre offerings….content of lecture was worthwhile though. Wandered down to SoHo, had a look around at a few places. Booked a ticket to Boston for Thursday. Ate a slice of mushroom and broccoli pizza….rather bland…but at least it’s some protein and some vegetables. Earlyish to bed in the vain hope I get up at a reasonable hour tomorrow.

Here endeth part II

Bleary-eyed and still half asleep in the cab to the airport, the scent of Jet-A1 transformed me from grunting sloth to elated and hyperactive meerkat at the sudden anticipation of an impending flight.

Sometimes I think that often the travel part of a trip is almost more interesting than the destination. Especially when that destination involves sitting in meetings for an entire day.

Today was no exception – partially due to the fact I had not slept overnight (why pack the day before when you can leave it to absolutely positively the last minute). I was already feeling slightly ready for bed by the time I arrived in Melbourne on the first flight of the morning. Alas there was no sleep to be had.

A day of meetings dragged on. I was amused at how inefficient the discussions were – which is to say, if I was chairing the meeting, it would have finished much sooner.

Dinner went a long way to consoling my fatigue. Melbourne’s “The Wine Room” on Fitzroy St St Kilda was the venue of our junket dinner and certainly provided a the taste buds with an epicurean adventure….

Note to self….carpacio == raw meat

Finally the long day ended, some 30 hours after it started when I made it to my hotel room. I was amused to note that the hotel in question actually has a “pillow menu” offering a selection of different types of pillow for the discerning pillow connoisseur. I was too tired to care….if only I’d booked a wake up call…

I’ve been to cardiac arrests before. I’ve jumped on chests. I’ve uttered the words “charging to 200 joules….stand clear”.

In fact, it’s refreshing to go to a real MET (Medical Emergency Team) call instead of the usual “I can’t believe this is not a MET call!”.

I have to admit though, I’ve never RUN a cardiac arrest before, but given my chosen specialty it was bound to happen sooner or later.

I’ve given up RUNNING TO MET calls because 9/10 times times they’re not really MET calls and, let’s face it, if it’s a real one, an extra 30 seconds isn’t usually going to make a difference.

This evening, I was bemused when there was a MET call in the Crit. Care Unit today – only minutes after I’d left the unit in search of food.

I wandered back up (steak sandwich in hand) to see it was in fact a real “Bona Fide” heart-has-stopped arrest.

Well actually when I got there, the heart was still beating.

Not for long.

Looking briefly at irregular rhythm on the monitor and saggggggggggging S-T segments, it was pretty clear the heart was complaining bitterly about a lack of oxygen. (screw you guys, this piece of ischaemic myocardium ain’t gonna take no more of this “thrombosis stealin’ muh air shit”….this little ticker is bustin’ its troponin-leaking myofibrils outta here!)

Now, usually it is the job of the med-reg to run METs. I’m quite happy to do my job – that is to say, I’m the airway guy. You need an airway, I’m there. I’m quite happy doing my bagging and masking and occasional tubing.

Today however, airway management just wasn’t enough. There was a Med Reg and an ED Reg running around like blue-arsed flies effectively achieving nothing other than stirring up the chaos and making a difficult task appear impossible.

The patient in question had decided to enter a peri-arrest state whilst on the commode. He had since been relocated to the floor….with his head in the corner of the CCU.

Bagging and masking, let alone intubation is not an easy task on the floor. Trying to do it squished in a corner was even more challenging (not to mention the aspiration of the dinner consumed moments before).

So with chaos abounding, defib pads flying everywhere and an awful lot of nothing happening fast, I took the opportunity to run my first cardiac arrest.

I was amused how cliched it sounded barking orders for adrenaline and atropine STAT! and muttering things about not having shockable rhythms whilst asking a nurse to get me intubation equipment. Simultaneously another nurse is cracking ribs with a pretty good CPR pace and the two other regs try to get IV access (why does the cannula always tissue just before an arrest).

When sipping delicious caffeine in Melbourne yesterday, suctioning vomitus from a peri-terminal patient’s oropharynx was not something that crossed my mind, and yet, as my steak sandwich sat cooling it’s tasty heels on the nurses’-station bench, I was down on my hands and knees sucking out chunks of custard from this poor gentleman’s lungs.

It’s amazing how easy time can distort. In the frenetic pace of an arrest, time simultaneously stands still and passes instantly. The time it takes to get an IV in seems interminable. A few minijets of adrenaline & atropine later accompanied by a disappointing asystolic “flatline” with it’s accompanying blood-chilling asystole alarm signals 15 minutes of futile advanced life-support. It seems like milliseconds have passed.

It’s amazing how strange it is to be the one person to call the arrest….that is to say to everyone, this is a futile effort, and then, with that, the compressions stop, the flesh turns a greyer shade of blue, and the fixed and dilated pupils stare emptily up at you as you momentarily glance at the clock…..

…time of death 1817hrs.

Requiem aeternum Joe Bloggs.

The asystole alarm continues to announce to the world the terrible event that has occurred. The staff look around at each other in an exhausted manner – physically, mentally and emotionally exhausting.

I go back to my (now cold) steak sandwich.

An in-hospital cardiac arrest is not a dignified way to go. Statistically there is about a 1 in 20 chance of surviving an unwitnessed in hospital cardiac arrest. I think if patients and their families knew what actually goes on at an arrest – and the dismal outcomes that happen more often than not….they would be more willing to accept an NFR status – that is “Not For Resuscitation”.

An NFR is like a “get out of medical jail free” card. Free from the undignified futile last attempt at keeping a soul on earth for as long as we possibly can. When your number is called, if the cards are stacked against you in the age and medical morbidity stakes….take the easy option – leave with dignity and speed.

Yay. Most everyone probably knows that anyhoo.

It sucks though that my hourly rate drops in the process. Not coping with that bit. Must remember the big picture stuff… Still can’t complain. Am at least employed and I am aware that there are less fortunate people who aren’t. Good things come to those who don’t piss off the karma gods though.

Dammit for choosing to live in Indooroopilly…..fecking miles from anywhere and a $22 cab fare from the city.

Sucks to be me. If only overnight transport was as reliable and as regular as it said it was.

And I have to be up in 6 hours….argh.

No fair.

Hope everyone has a smashing day (and I don’t mean that in any crockery dismemberment way or other such connotations).

It feels as though the air has been replaced with a thick lukewarm soup that we all must wade through.

Days pass with no sign of relief from the heat.
The evenings swelter at the marginally cooler 28 degrees.
The BOM radar shows no hint of rain….until…

…when it’s just getting to the point of being too much to bear
…when no amount of fannage helps appeases the angry heat
…we languish and swoon…

…the reds and oranges of a severe thunderstorm encased in the blue of lots of rain sweeps into view as it forms somewhere outside the 250km radar mark.

Inexorably and at it’s own pace….tracking in ten minutely updates we see relief is in sight….long before we can sense it in the air.

With fingers crossed we pray for the storm to hit us…instead of being a pissweak piece of shit and passing around us or petering out before us….

…slowly but surely…

The wind picks up and half of the sky turns from clear blue to dusky green…storm heads are silhouetted by the emerald green that heralds hale.

Confirming the sky’s ominous message … the BOM issues a warning…severe storms with large hale…

The radar tracks the inexorable passage towards us.

The maelstrom builds.

The cicadas signal warning as the air comes to a stand still. The anticipation gathers pace. The air is electric.

Lightening cracks in the distance.

The blackened sky is beginning to affect the visibility. People, previously doing impressions of fly blown corpses in the heat begin to reanimate these zombies as though life has been blown into them by the ominous call of the thunder that forms the baseline of the cacophonous symphony that has begun.

Scurrying.

Activity abounds…..

The wind picks ups….the clouds roll over….

The leaves rustle…

SPLAT. SPLAT……patter…..GUSH

The noise on the corrugated iron rooves suddenly takes over from the serene cicada fanfare.

The wind howls an eerie accompaniement…

Visibility disappears….

The storm is here.

…because I can’t think of anything interesting to blog about.

Well not entirely true. I can think of plenty of interesting things I have done since the last blog entry…but the point is I can’t think of an interesting slant that sets my writing apart from your standard run of the mill ‘today I did this, then that, then something else’.

Not that there is no place for such writing styles….just not here. At least….not here when I can help it (as I would be being hypocritical if I said it was below me to do something like that).

Of late I haven’t felt as if I have had anything original to say. I am struggling with that fact at present. Sometimes it feels as if there is nothing more original to say or to do or to create. It all seems to have been done before. Even what I am thinking and writing here is nothing original – it’s been thought about for eons.

If that were the case however, then there would not be any new songs, films, discoveries…blah blah blah.

Ironically it sometimes seems that way with songs and movies being rehashes of old ones….but that being said, creativity continues.

Maybe I’ve just become unreceptive to creativity. It’s becoming increasingly hard for me to find a good novel to read…I spent hours whilst overseas wandering through bookshops in many countries and only managed to find one or two books that I cared to read. Any suggestions….feel free to send my way

As for being creative myself….I should be so lucky. Continuously I have grand plans…but…when it comes to the crunch…

Motivation wanes even for my soon to be new career. I go through days wondering if I really want to work. But it I didn’t….going back to my old profession would be inconceivably uninspiring….

…so it’s a puzzlement what to do.

I was in the med school today handing in the orange piece of shit (thank fuck that’s out of the way hopefully for ever and ever) and I saw that they were once again holding interviews for next year’s cohort.

It’s hard to believe I have progressed slowly through the MBBS gastro-intestinal tract where I have been shattered into little pieces, homogenised, broken down and now I am languishing in the sigmoid colon of the med course waiting for that one last reflex to stir a commotion so I can be shat out the other end as a piece of bureaucratical excrement otherwise known as a doctor.

Me thinks the ‘hidden curriculum’ has well and truly had it’s effect on me. I thinks the course needs a bit of an aperient to get things in motion. I am sick of festering.

In other news, I have now finished all my clinical placements. My lit review (read: beautiful piece of fiction) for Obs and Gobs was due at 1330hrs today … I started it at 0930hrs. It’s amazing how creative one can be when there are deadlines. And I had it done with time to spare.

None the less…with the handing in of my last lot of assessment…that means all that I have left (supps aside) is 13 hours of exams and then I am free as a bird…until they bring out the buckshot-laden results shotgun and I am unceremoniously shot out of the sky of freedom into a puddle of unsavoury revision for supplementary exams.

Oh well. That’s ages away. So much procrastination to be done between now and then.

Today has been a day of achieving almost nothing. In fact, achieving almost nothing is the only achievement I have achieved today. So if that (achieving almost nothing) is not an achievement, then… I have actually achieved nothing. That would be a greater achievement. But it’s unachievable as to achieve the achievement of achieving nothing, you have to do just that. Achieve nothing. So I find myself in a circular argument. It is an unachieveable achievment to achieve nothing.

That’s an awful lot of achievements in one paragraph. Which further negates my original statement.

My head hurts.

It is a tragedy to assume that life has to be as it is…

I saw the above quote today….of all places…on one of those noticeboards that churches and schools have to attract the attention of passers by. Normally I find most of the propaganda on boards like that uninteresting or cringeworthy (not being particularly into subscribed religion), but today, I was impressed. It fills me with hope….in a world where “we regret to inform you that the light at the end of the tunnel is in fact an oncoming train or…has had to be temporarily extinguished due to no-one giving a stuff”.

Statewide rollout today. Remarkably it went without too many hitches. Configuration was completed by 0800hrs. Spent the rest of the day fielding calls from across the state – but nothing too stressful. Lucky… because once again sleep is up shite creek….2.5 hrs since 0830 yesterday morning until 3pm today.

Caught up with Dave and Simone today. Enjoyed a cup of “I can’t believe it’s not coffee” at their unit. Am borrowing their video camera so I can film Amanda’s wedding next week. Will also use this opportunity to download the 2004 Med Revue footage and edit into a DVD … even if it is a year late. Kits’ enthusiasm with TI has motivated me…that and people keep asking “when’s the DVD going to be available”.

Finally got off my butt and converted the GSE story on The Arts to a small downloadable file for any of the cast to download. Will put it on the website shortly.

I guess even though I have not done an ounce of study…and it’s TEN WEEKS or SEVENTY DAYS tomorrow until exams… at least I am doing more than sitting around doing nothing. Which is about what I could say I have been doing lately.

Acute Care Skills exam is on Friday. Thirty-minute multi choice. Hope I can bullshit my way through it as per usual.