Fraser Island

 

What more can I say ? ... a beautiful place.   Spent the day on a 4WD bus tour of Fraser Island on Thursday.  Today is my last shift here at Gladstone.   I will feel a little sad with the leaving.   I will post a final entry after getting home.

Free association - warning medical terminology incoming !

Overdose of dangerous amount paracetamol with (very) delayed presentation.
Spontaneous bleeding gums : Idiopathic thrombocytopaenic purpura.
Rest pain in a 36 year old 10 days post STEMI.
Guillain Barre complicating EBV in a 16 year old.
Penile fracture - transfer to Brisbane for urgent surgery.
Overseas tourist, snake bite - without envenomation.
Pool vacuum system injury in a child.
Chronic back pain ...
Mental health care services difficult to access on the weekends.
Patient with a CVA, not migraine.
Mother exhausted and stressed with young son's difficult to manage eczema.
Afternoon/evening shift to be followed with oncall overnight to be followed by morning shift !
Unresolved issues for patient's husband tainting presentation for unrelated problem.
Chest pain in IV drug user - obtains IV morphine from QAS on trip to ED - discharges self against medical advice - staff just managed to get IV cannula out in time before patient absconded - am I wrong being sceptical??
Cellulitis, skin infections - seem to be common - I wonder if its related to the warm, humid weather.
Some local GP's (still) expecting the impossible or impractical from "referrals" into ED.
Got paid for the first week today - a cheque arrived in the post at home (despite filling out paperwork and providing details for direct deposit ... no matter, at least its now in system and being paid)
Bush fires still a problem near home ... significantly effecting areas close to friends and family (not my own fortunately - yet)
Mentoring AMC trainees.
Teaching medical students.
Congratulations Heath on your Oscar.
Seeing familiar faces in the supermarket and the local pizza shop - small town ?
I hate Steam ( no not the hot water variety - you computer gaming geeks will know exactly what I mean and probably agree)
Six days and I leave for home.

Gladstone Midway

Weekend exploring ... not quite what was hoped but an interesting experience anyway.  Saturday I visited and walked around the local botanical garden, checked out Boyne Island and Tannam Sands and then headed inland a way, south and back out to the coast to see Agnes Waters and Seventeen Seventy - two small towns very close together near one of Captain Cook's east coast landings.   Overcast and intermittently raining.  After a wander around these two towns and a stroll along the beaches, I headed further south to Bundaberg with the intentions of taking one of the evening guided tours to the beach of Mon Repos where a conservation park protects the turtle laying and hatching.   I arrived at the information centre and looked at the display, but discovered one needs to book ahead - no tickets left for the evening tour.  Not necessarily a bad thing though - there was torrential rain on the drive back to Gladstone and no doubt would have made the tour most unpleasant, if not impossible.   It was certainly a challenge driving in the rain and the dark, with some places water on the road making the surface less than ideal, and the headlights of the oncoming semi-trailers/trucks intermittently a nuisance ... oncoming headlights being much brighter than the reflection of the markers on the road, the headlights temporarily made the road ahead very difficult to navigate until the truck passed.   Not at all a relaxing drive back.

 

Today, the weather has significantly improved - a little cloudy, but dry and sunny.  Interesting given the temperature was still around 30 degrees and the moisture from the previous day's heavy rains made it quite humid.  I walked along the beach area, then went back to the marina for a casual walk around the grassed areas (green and damp) and then bought some fresh seafood from the seafood market.  Looking forward to a nice piece of baramundi for dinner tonight.

 

The two photos I have attached are from the botanical gardens near Gladstone, and the beach (a very small one) in the more exclusive section coastal section of Gladstone.

 

I will be working straight through the next two weeks ... should be managable given when I am not working my time is my own and the working environment is good be in.  Gladstone is a livable city, but not a place I feel the need to spend a lot more time exploring.

 

Will probably post again before I leave.

First week completed

I have realised a week has passed.  It seems less imperative to post on my blog as I can speak with Lesley easily and have done so each day.   This post's photo is just one of the lounge area of my unit.

 

The weather has been kind here ... none of the extreme weather that has lead to the devastating fires down near Melbourne and the repeated floods further north.  Its quite surreal actually.  Today I planned going for a walk in the gardens or near the marina and it was raining.  With 30 degree temperature (30degree Celcius for those who still use Farenheit) and the rain, the humidity was quite high ... breathing was an interesting exercise in itself.

 

I worked the weekend and Monday, and had today (Tuesday) off.  The shifts are certainly full in terms of workload, with both Mondays being quite busy, and confirming the claim that Mondays are busiest.

 

The logistics of working in the Gladstone ED are interesting and suffer from a number of problems both self inflicted and imposed by the medical fraternity outside the hospital.   The admissions clerking is done by the ED medical staff, not ward staff.   This effectively adds another 30 minutes or so of additional paperwork to each admission through the department, contributing significantly to the waiting time in the department, both in delay of admission, and for those out in the waiting room wanting to be seen.  Given that this means ward doctors don't have to do this I have concerns that this lack of clerking by the ward doctors means they in fact don't know as much about the patients under their care as they would have otherwise .. and there is a risk that we, in ED, under pressure to keep up with the very significant demand on our time, we may well be a lot less thorough (mostly because of our problem focussed approach in ED) than what would have been able to be done if a dedicated ward doctor spent the 45 minutes taking a detailed whole person history and clerking the patient.

 

I notice also that nursing staff, the more distant they are from the coal face in terms of patient care in the ED, seem to have a greater value placed on holding that empty bed for that expected patient, Justin Case.

 

So looking outside, a number of newcomer GPs in town seem to be rather unaware of what facility Gladstone Hospital does and does not provide and possibly even lack a full understanding of the role of an emergency department.  Where-ever those GPs came from before they came to Gladstone, clearly MRI imaging was as easy as writing a prescription, and specialist access was only obtainable by getting their patients to deliver a referral letter in person to the emergency department.  I have not seen anything that causes me distress about the quality of the care provided by these GPs - it just strikes me that many have undoubtedly not set foot in the place and seem to have little concept of how to work in a community without a tertiary level care hospital on tap.  Anyone from the rural GP training or AMC mentoring programs who happenstance see this, please give these naive, well meaning GPs a tour of the hospital so they can see what is available and what is not, what is appropriate to send to ED and what is not necessary to.

 

I am delighted to see GP patients in ED .. hey, I am a GP too .. however, not when a template style letter is dumped onto a piece of paper from your computer records software, and then given to your patient with unrealistic expectations on what will be done on their presentation into ED with that piece of paper.

 

To those who asked, I am well ... no, I have not contracted dengue fever (although rumour has it that the mosquitos of concern are slowly heading further south from the hotspots up north) ... and with set shifts I am sleeping well and feeling relaxed between shifts.  Local shopping is as good as I can get at home, there is even a cinema walking distance from here.   I went to see Gran Turino Monday night ... a very powerful movie.   Many young actors that one can tell are new to the art, but Clint Eastwood portrays powerfully a character dealing with his own inner demons while a community around him changes and challenges his values and beliefs.  A very intensely emotional movie .. my only warning is that you may need the rolling credits at the end as recovery time before you leave the cinema.

 

Gladstone is not the tourist mecca that I experienced at Cairns, but there will be enough for me to explore this weekend that I have off.  I checked out town and the area around town last week (some photos with my first Gladstone post) so I will wander a little further a-field .. try to get some coast and inland.   I have a full week next week (week 3), and have agreed to work also a full week for week 4 of my stay, but the roster is not yet provided.  I am happy to do this, with set shifts and time off and a great group of people I am working with in ED, it will not seem a chore to work straight through the last two weeks.

 

My new experience this weekend past ... a stonefish sting .. and my role as an SMO in the ED was to reassure the doctor who looked after this patient that an antivenom was not necessarily a prudent thing to use.

 

I just want to finish this entry expressing my deepest sorrow at the great loss many have experienced from the bushfires of the past few days.  I worked in Shepparton during the fires of the early 80's and lived and worked in the Dandenong Ranges during the fires of the 90's.  I experienced some of the community angst of those fires, but never experienced the personal loss that I see others now experiencing.   I especially want to acknowledge the loss of life of someone I met many, many years ago, Dr Chris Towie.  I worked with Chris for a year and during that year he was of great professional support to me and I counted him at that time as one of my friends.   

Go well Chris.

First two days

Welcome to Gladstone folks. First two days were morning shifts in the Emergency department, interestingly the first day's (Monday) numbers were the busiest for the ED for over a long time, no I won't take credit for that ! Tuesday night was on-call and had two calls but quite manageable.

Today (Wednesday) and tomorrow I have rostered off. I woke normal time, about 6:30am ... but as Queensland does not have daylight savings it was the same as 7:30am for my body clock so no difficulty waking and getting up. A short wander around town, down the the Information service at the Marina and gathered up a handful of tourist brochures for perusal to decide on what to do for days I have off here.

3G mobile phone (and therefore also internet access) is good, so phone communication with my family is easy. The weather has been overcast, humid and in the low 30's. I have escaped Melbourne's heat and dry. Today has been raining lightly on an off all day. I drove a little north west of here inland for a look-see ... the green is certainly prominent. There seems to be a lot of land dedicated to raising cattle and a huge amount of coal is being shifted along rail into the port for shipping from Gladstone. There is a power station, aluminum smelter, many other industries and a very large industrial shipping port here. I must read a little about what makes Gladstone what it is.

The photos today are the hospital, the building where I have been given a unit ( mine is on second floor so no significant views to the distance) which is well appointed and air conditioned. The third is one from the lookout towards the marina.

I will keep in touch every few days.