Last Thoughts on Launceston...

Obviously that's not true. But, if you've never read/heard Dylan read "Last Thoughts on Woody Guthrie," you should. (http://www.youtube.com/watch?v=NVbr0y8zp68&feature=related)

Anyway, wrapping up things in Launceston, Tasmania, Australia. It hasn't been easy-- I feel more like I'm trying to flee the Nazi take-over of Paris than simply move. Partly because they scheduled me to work 7 overnights, two days off, then work the two days prior to my flight early the next morning. Hope all my 9-to-5 stuff is taken care of! Nothing like a good-bye scheduling kick in the teeth to make you feel appreciated... :) In any event, below are a few thoughts and a few shots about the job bits of this past year. It was said almost to the point of cliche, but certainly working with the staff at the hospital was the best thing about working there, and if we get to work together again in the future I hope we'll have kept our sense of humor!

Another day in the pit--Rob and Jeff obviously working hard. And below, a picture of much of the group and many of the groupies that make up the face of the DEM!

Why people first start working in Emergency (and likely any) Medicine is often very different from the reasons people continue to work in it. What was the US survey that just came out saying that medicine (& nursing-- the distinctions between them are increasingly nominal, effectively turf-posturing and financially motivated) was becoming an increasingly dangerous job? Why bother putting up with the abuse? Well, to wit:

"...Eliminate the patients for whom the 'aha!' moment of connection will someday arrive. Eliminate the patients for whom we have the capacity to transfer to others, who have the resources to go elsewhere for care and who would be happier and better off if they left. That leaves the patients whom all physicians would equally find difficult (if not downright detestable), and who for whatever reason-- lack of insurance or of other resources-- have no place else to go. If medicine were an ideal profession, we would divide among ourselves the care of these difficult patients as evenly as possible. We are far from an ideal profession, so many of us are able by virtue of specialty choice or location of practice to avoid having to encounter such patients for the most part. Others, who work in emergency departments or community clinics in low-income neighborhoods, get far more than their fair share. These latter physicians deserve our thanks and our respect. They often receive neither. Whether we have a lot of or a few of such patients to care for, that care demands professionalism in the strictest sense of the term. One opposite to professional is amateur, which in turn is derived from the word "love." The point of calling ourselves professionals is that we are supposed to deliver high-quality care for people for whom we feel no love or friendship. Military physicians, for instance, are charged by the code of military justice with treating wounded enemy combatants-- who perhaps a few minutes before were trying to blow up the army hospital-- with the same standard of care they would deliver to our own soldiers. These are demands of professionalism. The outrage we justifiably feel when these standards are breached indicates that we believe that these standards of professionalism are both appropriate and attainable. Abraham Lincoln once said, 'My father taught me how to work; he never taught me to like it.' Medicine is our work. Most of the time, for most patients, it is worth doing our best to like it; we take better care of more patients that way. When we cannot find ways to like it, it remains our work. We should do it as well as we can manage." -- Howard Brody, "Ethics Forum," American Medical News, July , 2006.

There are certainly a few of the locums folks who make their way back specifically to the LGH from time to time, and that in itself is proof that the staff working there are something special! Beer all around for the LGH Christmas BBQ...

As for myself, I'm still trying to rent a house in the US for my next gig/incarnation. The Louisiana Medical Board and the Australian Medicare Levy Exemption folks are my latest and greatest frustrations. I guess being an ER Doc w/ the attitude of "Well let's just get it done now" doesn't train you to be super-patient when dealing w/ other things. But what I certainly can say, is that if I'm ever in a nursing home, I want my drug chart to look something like this:

Yup, mostly just standard nursing home whatever, but at the very end there, hand-written, is the order for "one beer at night, prn [latin for 'as needed']." I seriously want whoever did this to be my doctor. Of course, the more savvy of you order-writers out there will notice, the "prn" indication is not specified, as in "paracetamol prn discomfort/fever." "prn ennui" would be my choice in this situation...

So, that's that. I just wanted to put a few pictures down here of some of the goodbyes and good folks that made up my last few days in Lonnie!

Trouble wears many faces. Most often suspiciously cute, innocent faces...

As above, but I would also like to mention the look Jake is sporting-- sort of an "astronaut with pashmina" feel to it...


Folks saying goodbye to Mel and possibly myself at the Jailhouse grill....

Here we see newly minted Australian citizen Young w/ her certificate, and here is Baby Possum giving me lessons in time-management....

"Time management," giving the impression of needing to be "looked after"-- I think these are the prices I pay to do what I think needs to be done at work. They're especially chafing to someone who values independence and self-sufficiency as much as I do... :(

"Presumptuousness and self-importance are the wounds this life imposes upon those privy to the wounds of others. The busy, capable doctor, well aware of all the burdens he must carry, and not in the least inclined to shirk his duties, may stumble badly in those small moral moments that constantly press upon him or her-- the nature of a hello or goodbye, the tone of voice as a question is asked or answered, the private thoughts one has, and the effect they have on our face, our hands as they do their work, our posture, our gait." -- Robert Coles, The Doctor Stories, by William Carlos Williams, introduction

So, anyway, there you have it. Transitioning back to the US, visiting some friends, trying to figure out what to do with myself. Jake admitted to me he wanted to take a picture of my goal sheet for my year in Tasmania (yes, the one that included "9-minute mile for 1/2 marathon" and "sort out life") from the fridge and ask me how I did. Must say, not all that well ('pot belly' does not equal 'core strength'). But such is life. I'll leave this stage of things, and perhaps sign-off w/ the following. See you down the road a piece...

"Serving is different from helping. Helping is based on inequality; it is not a relationship between equals.... When I help, I am very aware of my own strength. But we don't serve with our strength, we serve with ourselves. We draw from all of our experiences. Our limitations serve, our wounds serve, even our darkness can serve... Helping incurs debt... But serving, like healing, is mutual... I am as served as the person I am serving. 'Fixing' is a form of judgment...In fixing there is an inequality of expertise that can easily become moral distance. We cannot serve at a distance. We can only serve that to which we are profoundly connected-- that which we are willing to touch. This is Mother Teresa's basic message. We serve life not because it is broken but because it is holy.... If helping is an experience of strength, fixing is an experience of mastery and expertise. Service, on the other hand, is an experience of mystery, surrender, and awe." -- Rachel Naomi Remen, "In the Service of Life," 1998, reprinted from Noetic Sciences Review, Spring 1996

"And so the moral of the story /

I guess it's easier said than done /

Is to look at what you've been through /

and to see what you've become .... "Private Conversations," Lyle Lovett