a few weeks in...

It's cold here-- about 4 C in the am and 14 at a high. But it is also their depth of winter, so it's not going to get any colder. I've got the power and hot water set up finally, but the heating is still not working. Got a bank account, cell phone, internet (finally) and will start working on bathmats, window insulation, drivers license, etc. (right now driving without, which is interesting on the left...).Had a meeting with the ED director yesterday am (I'm writing this at my 09:00 on Fri am) and saw some of the ED. No one wears scrubs- the nurses' uniforms are like school uniforms (slacks, button shirts, sweaters/vests) and the docs wear their normal clothes. I'm thinking I'll have to break in the whole scrub top thing...

Tasmania is about the size of Scotland or Sri Lanka, ½ the size of Lake Superior, a bit smaller than Ireland, and has a population of around 1 million people. It's about 5-10 years behind the times, depending on who you ask. Launceston or “Lonnie” is the second-largest city in Tas, just behind the capital to the south, Hobart. There's an interesting history there, if you're inclinde to read up on it. Suffice to say that there continues to be a bit of a rivalry btwn the two centers. Lonnie has an immediate “greater” population of about 100K, which is less than Hobart. However, the north of Tasmania, an area served by the Launceston General Hospital, is home to the bulk of the population, spread out as it is, so the hospital can get a bit busy. With the flu season, confirmed to be at least partially H1N1, the past and current months are shaping up to be the busiest in the LGH ED (about 122 visits in a day, up from a prior max of 102).

One of the biggest set backs is that The Daily Show full episodes are not available in Tassie/Lonnie via the wireless... The countryside is quite amazing. The climate is temperate and forests still take up most of the island, so there's an opportunity for some “bushwalking” or hiking/camping. So far I'm walking pretty much everywhere in the city, as things are that close. Between Hobart, the capital, and Lonnie is mostly grazing (yes, sheep) country. In the city, the air is cold, and scented with woodsmoke, still a major source of heating for many in the city. The overall impression is that of Scout camp-- walking outside in the morning surrounded by the crisp fog and hint of woodsmoke, it's easy to recall mornings in Camp Katoga headed up to the Trading Post. The other memory this place evokes in me is that of the northern desert/forest of Argentina (I forget what the area was called, but it was north of my friend Augustina's home in Tucuman...) They say that smell is the sense most tied to memory... Finally, the pastoral/rural picturesque architecture and overcast skies makes me think of old BBC-America shows that my mother watched on Saturday mornings-- usually involving a “pepper-pot” old English lady solving murders.

The medicine is interesting. Just little “Royale with cheese” differences. Brand names for drugs are obviously all different. The formulary is a little different as well (roxithromycin is the macrolide of choice), and practice is very different. For example, I don't think I've ever sent home an 86 yo with chest pain after two (-) sets in the States. And I've certainly never done a Bier block on a 79 yo for her Colles frx! But, there you have it. So far I've had a woman come in in rapid afib, degenerating to sick-sinus with long episodes of asystole (you read that correctly) that increased in symptomatology and length, and a woman who showed up in shock with cyanosis, mottling, cold extermities, and perfectly intact mental status and vital signs. Still not sure about that one... apparently no brown snakes in Tassie (60% of the mainland's fatalities) and no useful history from her or her family...

People are very nice so far. By now writing the blog after my second week here (1st working week), I've met a few folks and have gotten the place and the other stuff pretty well set up, but not yet out about town very much. I've put up a clothesline inside the living room, which makes me look pretty classy... There's a 10 k race (how far is that, anyway?) in October I thinking about dying on, and apparently a mixed-martial arts club in town. We'll see... :)

I've included an email I wrote to a friend of mine asking about my ED work experience over here as it may give another POV.

Hey ---,
I'm trying to continue blogging what's up here in Tassie, so if that'll be helpful it'll be at www.doctoroffortune.blogspot.com
To try to answer your question, though, it's been good so far. I've been working for about a week as a Registrar, which is basically equivalent to a Fellow. I was told this is because I'm not Board Certified, but I'm not sure about all that. The Consultant/Specialists (“Attendings”) in Emerg where I am, and in most places it sounds like, tend to not overnight in the hospitals. They get called in for major things. So far, haven't been on overnight by myself, so not sure how that will work. The drugs are a little different, the abbreviations very much so (GORD for gastro-oesophageal reflux), and the follow-up practices different as well. The other day I was corrected for ordering an afterhours sono on a Pt to r/o ectopic in a preg vag bleeder. It was felt it could wait until morning, as she was hemodynamically stable and not peritoneal. They would've had to call in the consultant radiologist and apparently that's not easily done (“that HCT can wait until the morning-- we'll just observe the intox 82 yo potential head trauma until then...”). So that's taking some getting used to. Obviously no separate Peds ED...

I guess the bigger city trauma centers are more like what we're used to, but I don't imagine they're in much need for locums. Lifestyle is fine, though taking some getting used to. The environment and social scene where I am is a bit like where I grew up, so it's something I understand if not entirely enjoy-- things close down pretty early. But it works for me for now, hanging out, reading, getting back into some extra-curriculars I'd let go. Pleasant enough co-workers, though I do get the feeling that people say “no worries” when actually there's room for improvement if they would just tell me where!

So, hope that's helpful. Moving overseas was expensive and kind of a pain in terms of getting banks, post, internet, new phone, buying new electronics done. But the whole thing's been interesting, which is all I'd hoped for. Let me know if you have other specific questions, and I'll be happy to try to point you in the right direction...