This piece of music is not what I am writing about today.

Yesterday I received a phone call from the Director of Anaesthetics informing me of two things – firstly I have a PHO job next year and secondly I am about 10 or so places from the top of the waiting list for the training program.

Both of these pieces of news made me somewhat rather elated.

Last night, having a day off today, I went to investigate a new and rather up and coming establishment in Paddo – The Lark. A cocktail/speakeasy kind of place you can go and enjoy good food good drinks and fantastic coffee.

Highly recommended if you don’t mind paying a little more.

I put in my first central line this week. There is something slightly disturbing about sticking a very sharp and very long thing into someone’s neck (albeit with an ultrasound and some anatomical landmarks to help)….trying to find the jugular vein whilst avoiding other somewhat slightly important structures (say for example the carotid artery). Not only that, once said vein is located, the next step is to feed a somewhat long wire downwards….towards the heart before feeding an even bigger tube over the wire (whilst holding on to the wire at all times ———allegedly there’s several wires that need to be retrieved each year in this state alone because somebody forgot to hold onto the wire).

I was successful in my first central line placement. **golf claps**

I was going to also insert a VasCath (that would be a vascular catheter) into someone also to allow them to be dialysed. Fortunately or unfortunately the patient turned out to be coagulopathic (which for the layperson means they could easily bleed like a stuck pig). The consultant had the honour of inserting the aforementioned catheter – with a diameter only slightly smaller than a garden hose into the groin of the renally compromised patient.

Perhaps the most intriguing thing I did this week was a bronchoscopy. Bronchoscopy is the art of feeding a fibre optic cable down into the lungs of a patient and among other things sucking out mucus. This seems fairly straightforward in theory until I was informed that there are a number of areas of the lung to be visited (a road map was drawn for me). To make things a little more challenging, the control of the direction of the bronchoscope is controlled in one dimension by a joystick kind of device but for the other dimensions you actually have to physically twist your entire body around an axis in order to safely rotate the fibre optic cable. This has the appearance of an interpretive dance – the operator has an eye attached to the bronch’ and is hunched over the patient’s head with the cable feeding down the tube into the patients lung. As the operator navigates and traverses the various segments of the bronchial tree (and seriously down there you just about need a GPS), they can be seen writhing and twisting in a hypnotic manner in order to align the scope in the right direction.

… an art that I am yet to muster. I think these devices should come with driving lessons. Luckily after I managed to view a few of the lung segments, the consultant was on hand to locate the other segments and aspirate a creme-brulee-like substance from the lungs. Mmmm tasty.

Six months almost to the day since I was last arsed to write.

And my writing ability, let alone powers of narration have been shot to all buggery.

So a quick round up of the last six months in a single…..neologism:

walzingmatildabusychestdrainQANTASmuseumsingaporeshortcoursebadlandsprivategenmed-
-moreTPLTtimeshoppinginmelbournevisittotassieshowsgaloretoseesnowboardingingin-
-newzealandbonebreakinglydullorthopaternalandmaternalvisitsonwaitinglistfortrainingprogram….

(I wonder how much that would score in Scrabble – assuming there was a board big enough and enough tiles… I might one day get around to expanding on the above.)

….which brings me to today.

PHO (Pronounced P-HO – as in just a little skanky)….Principal House Ossifer (the lysdexics I’m sure will sundertand) in ICU and Anaesthetics.

First 12 hour shift.

I’m still alive.

My patients are still alive.

So in a nutshell….probably could be counted as a success.

Pros of the job:

• 12 hour shifts mean rostered paid overtime and only needing to work for days a week
• I save half an hour of driving not having to come home in peak hour
• I feel less tired even though I’ve done more work (this may change – it’s only day one)
• I don’t have to iron or wear shirts/ties
• Patients with tubes in their throats can’t bore you with mundane and seemingly irrelevant facts – “it was a monday…no it was a tuesday…..yes yes I remember it was a tuesday because Gladys bakes for the CWA cake raffle on tuesdays….” (I only care about the fictitious Gladys’ cooking if she’s laced it with strychnine in a bizarre misguided homocidal geriatric way and I have to deal with the aftermath of said axis of culinary evil)

Cons of the job:

It amuses me that the people who I was phoning for advice last week are phoning me for advice this week. This does not seem right.

I will either get really fat or really skinny – not sure which yet – no time to eat, but when there is time, there’s only junk food (unless I get of my buttoony on days off and cook….thank you Dr Joshi and your chicken soup recipe…and of course to Miss Ali for introducing me to Dr Joshi).

I’ve graduated from sticking sharp things in a short distance in a limited number of places to “sticking sharp things in a bigger distance and poking longer things in many more places “. It still sucks to inflict pain though – especially when the patient gives you a look that says “you’re enjoying this you sad sadistic bastard” to which I return the look with a look that says “if I had a choice between sticking sharp things into you or relaxing with a cup of coffee and a game of Scrabulous….I’d choose the latter – so long as it’s a good cup of coffee (and plunger-at-the-very-least-as-a-bottom-of-the-barrel last option and we will not even permit anyone to suggest that anything with the word “granulated, international, caterer’s, or 43″ is even a poor subsitute for coffee)”.

Enough rambling. Sleep is necessary if I hope to pull off another 12 hour day.

Note to all and sundry (particularly the sundry): There is a very large amount of tongue in cheek in this post in case you were not aware so before anyone thinks this is newspaperworthy-scandalous-health-revelation material, think again.

When one is to turn on the cold tap out here, cold water is not something that should be expected.

My shower last night was a ‘cold shower’ that was about as warm as my normal shower.  The water being bore water is hot when it’s pumped out of the ground. 

It also smells like rotten eggs.

I’m sure that you could charge a fortune if it were relabelled as a health spa.

My motivation to study is also running hot.  Not sure why.  Might have been motivated after a day of slothfully watching Austar and getting fed up with rerun after rerun.  None the less, I spend a good solid evening actually answering SAQs and found it thoroughly fascinating actually understanding a thing or two.

Of course study motivation turned into a late affair so minimal sleep last night made for a tired and cranky soul this AM.

A nanna nap at lunch time rectified the situation.

What was not so hot today was the realisation (after a phone call to pay office) was that I was not going to be paid this fortnight unless I submit signed timesheets.  Nice of my beloved employer to inform me of this fact.

Frenzied emailing of forms and faxing of forms needing to be signed by everyone short of the upstairs.  I will however allegedly be paid. 

Off to TCLT No. 2 tomorrow.  An hour’s drive from TPLT No.2.  Morning clinic and then back to TPLT No.2 for an afternoon clinic.  Fingers crossed there aren’t many bookings in either.  Surprisingly enough I want to get back to the books.

Hope the motivation lasts.

Every day out here is like a Sunday at the Grandparents.  Wandering in to the hospital each morning, your nostrils are assaulted with the smell of a silverside boiling away or a roast beast of some sort cooking sizzling and crackling in a hot oven.  By morning tea your stomach would be rumbling at the anticipation of the impending luncheon.

Certainly I have had my fill of roast dinners in the last few weeks followed by delicious treats such as steamed pudding, jelly and custard and bread and butter pudding.  It sure is good old fashion wholesome country tucker, and since it is provided to me free of charge, three times a day every day, one would think it almost heretical to cast aspersions on such an apparently idyllic setup.

However, there is this concept of “too much of a good thing”.

Coming into my third week, I have probably consumed more meat than I have in the entire two months prior to me heading off into the sunset.  I have eaten probably thirty percent more meals than I would usually (allowing for the fact that I am normally in such a rush to get out of bed on to work that I usually don’t eat brekky).

To tell the truth, while all of this food tastes really good – I am reminded once again of the visits to Gran and Grandad where the meat and three veg meals usually meant vegetables boiled in brine to within an millimetre of their blanched existence and roasts that you had on Sundays – and then saw cold for lunch or refashioned into something else every day for the next week until the side of roast had been used up. (Blood hell that was a very long an protracted sentence – one that I really don’t feel cogniscant enough to reword).

I find that I am pining for a spicy curry from Punjabi Palace or a plate of yiros from Lefkas.  When I feel like a salad, I long for the friendly dark-green leaves of baby spinach instead of anaemic looking lettuce leaves.  Bring on the cubes of fetta, kalamata olives and garlic dressings.

I guess in the twenty years or so since I last had a Sunday dinner at the Grandparents (who have since moved twice – first to a retirement village and then onto an address with a celestial post code), my tastebuds have broadened their horizons.

While it’s nice to take the occasional gustatory walz down memory lane – I think I will be glad when I am back to a more cosmopolitan smorgasboard of flavours.

A quaint little town to say the least. 

Once you are free from the foothils of the Great Divide, things flatten out.

TPLT No.2 is situated on flat wide vast sweeping countryside.  Mostly grassand low lying scrub for miles around. 

There was the most awesome sunset last night as I was walking back from the Hospital to the doctor’s house.  Serene, not humid, and you could pretty much see for miles around as a soft warm breeze whispered through the grass that was silhouetted by the sun dipping over the horizon.  Sublime.

TPLT No.2 is filled with….well…weird people.  I was told this by the people at TPLT No.1 but I must admit I was putting this down to inter-TPLT rivalry.  But ’tis true.

Because of the extended stay in TPLT No. 1 I am only here five days and leave Friday morning.

TPLT No.2 has its benefits though:

• A real three bedroom house (as opposed to pokey flat at the back of the GP practice).
• Austar Sat TV in the doctor’s house
• A car (not that I really actually have anywhere I could drive to – there isn’t much within the half hour on-call reaches of the town).
• A paramedic…yes a real one who can do real paramedic stuff (TPLT No.1 had the gardners and admin officers on the roster for driving the ambulance…making it a little difficult if the one experienced driver was not rostered on).
• Mostly agency staff (which usually means nobody knows anything because they are all on short term visits like me)…but this time around, at least 4 of them have critical care/emergency/intensive care backgrounds – which (perish the thought) should there be a serious emergency, would hopefully mean I have lots of backup
• It is within less than an hours drive of the nearest other doctor – so I don’t feel quite so isolated.
• I get paid OVERTIME.  Instead of being on call 24/7 and having to deal with whatever came through the doors at whatever time, if I get called out outside of normal working hours, I will get paid call out rates! YAY.

So I have three working days in TPLT No.2 with a visit to TCLT No.2 for a half day clinic also.

In other news,  I’m now over half way through my Tour of Duty!  Two weeks today I fly out to Singapore for some much needed retail therapy.

Was supposed to leave TPLT No. 1 last Wednesday.  Alas, however, the powers that be decided that as the permanent doctor had called in sick (to stay in Brisbane a few more days) I was to stay until the following Saturday….Easter Saturday.

Not so much of a problem in itself – the staff are great and it’s not overly taxing. 

Problem is, first of all, I had my mind all keyed up to move on so it took a little mental adjusting to stay, and secondly, there were an awful lot of patients booked into the GP clinic fully expecting to see their regular doctor.

For the most part that was okay – they didn’t mind.  I did get a few people reschedule.  I was however having minor conniptions over some of the patients whom I’d seen the previous week and felt that they were a little beyond my ability and had asked them to rebook the following week (fully expecting them to be seen by a ‘real’ GP)… effectively buffing and turfing (read the House of God by Samuel Shem).  That of course had now backfired which mean I actually had to put my thinking cap on and make several phone calls (and skype calls) to various medically trained people around the globe seeking advice on the best course of management for some of these more complicated cases.

I think I managed. 

Karma of course came and bit me on the arse though – in the form of a stream of sick kids.  Paediatrics is not my forte.  In fact, the last time I did any paeds was in medical school – and in another country.  That meant several more phone calls, MSN messages and skype calls around the globe for more advice.

Thank fuck for the internet.  It has made it so much easier to provide a minimum level of health care to people who live beyond the reaches of the southeast corner and coastal areas.

Easter Thursday I actually ended up with a bonafide inpatient.  Kind of weird actually having an inpatient that I am totally responsible for (as opposed to being papermonkey for a registrar).  I am surprised at actually how much stuff I remembered when I had to and how much things became suddenly clear that I had never really quite understood up until I was forced to be making decisions on my own….without a pathology service or even a teeny weeny iStat(TM) to assist with decision making.

So with Saturday arriving, so ends my time in TPLT No. 1.

Bike vs Ant Hill guy was flown out by RFDS tonight and I went to do the hand over. 

The council bloke buzzed the runway a few times to scare the wildlife off (8 million dollar hunks of machinery don’t like running into Skippy – it tends to cause thousands of dollars of damage….not to mention a bloody mess is made of Skippy).

It looks kind of cool seeing the light appear ‘like an angel on the horizon’ in the distance and land making lots of noise and flashing of lights.

Tonight Foxtrot Delta Romeo was visiting us.  The RFDS planes have the call sign Victor Hotel (for Australia) and Foxtrot Delta – followed by another letter.

It’s a relief when the door hisses open, the ambulance ambles (love that alliteration) onto the runway and you can finally hand the patient over. They’re no longer your responsibility…and you can go home and put your feet up and hope to hell the phone doesn’t ring with another conniption to deal with (fear the phone).

Thank goodness for modern technology.

So much for quaint little village.  (I’m not superstitious but I am not going to mention that other Q word because it’s been bad enough already).

Monday….(cue Pier Gynt Morning Suite)….beautiful sunny day, birds singing, clear blue skies, I sit down to enjoy my porridge and scrambled eggs (kindly prepared by the kitchen)…enjoying my plunged Merlo coffee (I bought the stovetop espresso maker but forgot the basket that holds the coffee) when the phone rings.

Fear the phone. (cue William Tell Overture)

Cow vs Girl…. on a cattle property…..1.5 hour drive from TPLT 1.

Funky, bumpy ride in the 4wd ambulance out to the station along very bad dirt roads.  Lucky me sitting in the front seat was on gate duty…..opening and closing the innumerable gates that we had to traverse to get to where we were going.

Girl in pain. 

Very slow ride back to TPLT 1 hospital…bumps and pain don’t go well.

Patient was tranferred eventually to NBH (Nearby Big Hospital) by private vehicle.

That took all day.  All GP patients had to be cancelled.

TPLT 1 Day 3

Busy Busy Busy day in GP clinic (cue theme from Benny Hill) – fully booked out because of yesterday’s cancellations and also not having had a GP for weeks.

Thank goodness for prior knowledge.  Would never have made it through the day and the multitude of patients without the stuff I’d learnt whilst a pharmacist.

Only saving grace is the Moo-Lah. 

TPLT 1 Day 4

Alledgedly a half day of GP stuff for me.  Allegedly.  Still totally booked out for that session.  Then a few more patients to see in the hospital OPD.

Much sleepage had in the afternoon.

TPLT 1 Day 5 (With a visit to TCLT*)

TCLT has a clinic on Fridays.  Was driven half way.  Picked up by Bush Nurse in ambulance.  Very enjoyable clinic.  Very brief tour of the town.  A few bizzarre tourist attractions.

Very nice lunch put on by Bush Nurse and Receptionist.

Driven back to TPLT. Fell asleep very early.

TPLT Day 6

Woke by phone (fear the phone).  Didn’t remember actually falling asleep.  Must have needed sleep.  Luckily phone only required a phone order.

Wouldn’t you believe it.  This weekend would be the weekend for the TPLT 1 Camp Draft.

Camp Draft = Cattle vs People = Work for me.

Fractured tib/fib required flying out.

Busy GP clinic in the AM.

Bloke on Motorbike vs Ant Hill

Ant Hill 1, Bloke on Bike 0.

Cringeworthy displaced humeral head (humerously[sic] not funny).

Second aeromedical retrieval for the day…and it’s only early afternoon.  Things come in threes…and there’s still another day and a half of Camp Drafting.

I think I need a Becks and a good lie down (double entendre intended).

Was muchly impressed to find that my washing was not only washed, but ironed and foldeded.  Could get used to this.

*TCLT = Tin Cup Little Town (i.e. much smaller than TPLT).

Flight was in a Dash-8.  Flight attendent was nervous as all buggery as it looked like he was being assessed (stern looking flight attendent seated accross from me ticking and flicking forms and watching him like a hawk).  I felt sorry for him because I think his nerves made him sound very unpolished.

One hour wait in the sweltering heat at the airport because the hospital car was being serviced.  Trip to TPLT No.1. from NBCT* was via the photocopier shop to ascertain the status of the hospital photocopier repair and via the pet shop – to purchase a new fish for the hospital fish tank.

Two hour drive from NBCT to TPLT No.1.  Most entertaining conversation with the gardener/ambulance driver and an EN that were in NBCT to pick me up and do errands.

Arrived in TPLT No.1.

It’s sooo cute.  The hospital reminds me of A Country Practice.

Weatherboard.  Manicured lawns.  Very 1950s.

Reliever’s accomodation is spartan but comfortable.

Turns out there’s been no doctor in town for four weeks…hence the private practice clinic is full up.  GROAN.  I’ve never actually had to deal with private practice before.  Could be somewhat rather hellish.  Will not be impressed if it’s pap-smear central

The hospital runs its own ambulance.  There’s no paramedic.  The area covered is 22,000 square km covered by this hospital meaning a callout may mean a two hour trip out to a station somewhere.  Doctor to accompany in serious situations.

Could be a very interesting time.

*TPLT = Tin Pot Little Town

*NBCT = Nearby Big Country Town