We're off again...

This will be brief because I'm quickly trying to pack and finish up my work for the day.  Matt got his September and October schedule this week and he happened to get this Saturday-Tuesday off.  We couldn't waste a 4 day weekend so we made some last minute plans to take a sailing trip around the Whitsundays, a famous (and gorgeous) chain of islands about 3.5 hours south of here.  I posted a picture from Google images, but we'll have a bunch of our own to post when we get back.  We're leaving as soon as Matt gets off work today as the ship leaves bright and early Saturday morning.  We get back to shore on Monday afternoon, so we'll head back to Townsville then.  

Photos

We don't have anything new or interesting to report really, so I thought I'd post a couple photos of our new apartment at the Watermark complex. The first one is of course of our kitchen area (pardon the mess), and the second photo shows part of the main living area (I'm currently working on the dining room table there until we pick up a desk to put in the guest bedroom). The third photo is of our patio, and the fourth is the view of the pool from our patio. It's a great place and in a great location. And it even has a bar/restaurant on the first floor that happens to be the big social spot of Townsville on Friday nights and Sunday afternoons.

Also, here is a link to the photos from our trip to Undara:

http://picasaweb.google.com.au/matthew.berkman/Undara?feat=directlink

Monday evening Matt and I went to the gym here at Watermark (it's such a blessing this complex has both a pool and a gym). We have been relatively active since we moved to Australia back in July. We climb Castle Hill and go running along The Strand quite often, but we haven't set foot in an actual gym to lift weights in 2 months. Needless to say we were feeling really out of shape, but I'm hopeful it won't take us too long to feel normal again. Tonight I'm taking Matt to a pilates class which should be interesting. He's even agreed to go to a yoga class with me sometime. I feel like I should take my camera along as proof :)

Outback yes....Bloomin Onion no!

It's Monday again in Townsville. Lindsay and I just finished a wonderful meal of grilled lamb and a goat cheese/fig/tomato/spinach salad, which we washed down with a nice South Australian Pino Grigio. Don't think for a second that we don't know how incredibly lucky we are to be here enjoying this amazing experience.

Last weekend was no exception. After a bit of political maneuvering I was able to wrangle last Friday off. At 10:30 we left Townsville and headed into the interior of the continent. A bit melodramatic perhaps, but this was our first venture into the real "Outback". By the way I did ask our Australian friends when we would know if we were in the real Outback. They said if the ground at your feet is red, you have driven more than 4 hours to get there, and the locals ride horses, you are in the Outback.

So from the low coastal plane we crossed the Hervey Range Mountains for about 130K until we hit a T in the road. We swung a right and for the next 4 hours we played chicken with the Road Trains. I have done a bit of traveling, but I have never seen anything like this. For hundreds of kilometers there is a single lane road that is to be shared by all. When I say single lane, I don't mean one for each car. Essentially you drive on the one lane until you see something coming at you on the horizon. If it looks small or medium, you steer your car half the way off the road so your two outside tires are kicking up red dust. If it looks like something out of the Road Warrior you pull off as quickly as possible and pray. The Road Trains are semis pulling 3-4 trailers behind them. The ground shakes as they pass by. Needless to say, we were very cautious. The other tricky part of driving on the road was the hundreds (honestly) of kangaroo/wallaby carcasses that littered the road. The beasts see the headlights and freeze. Road Train 1, kangaroo 0.

We listened to a dumb book on tape and after 3 hours stopped at a "roadhouse" for a chicken burger and some chips. 2 hours later we arrived at Undara National Park, home of the famous Undara lava tubes.

We checked in and got set up in our campsite. About an hour later our four other friends arrived. Friday evening was a typical camping night with a fire, sausages and roasted marshmallows. By the way, we need graham crackers. We have been talking up the s'mores and even though it shouldn't be hard to impress a culture that enjoys vegemite, a s'more without graham crackers just isn't a s'more. (Lindsay was very content however with a roasted marshmallow sandwiched between two chocolate chip cookies).

The next day we took a tour of one of the lava tubes. For those that don't know, when a volcano erupts and the conditions are right, a natural cave/tube is formed. We took the tour with about 20 other people, not one younger than 70. Apparently they are referred to as the "Grey Nomads," the elder folk that roam the country in camper vans in search of cheesy tours and early bird specials. They were nice enough. One of their campers had the greatest slogan I have ever seen: "Adventure before Dementia" (which to be truly appreciated must be said with an Australian accent). I was thinking of adopting it as my own until I came up with a better alternative: "Adventure before Placenta" (which also sounds better with an Australian accent). Lindsay thinks this is gross.

After the lava tour we returned to the campsite and Lindsay and I went on a "Bush Walk" with two of our friends who happen to be biologists. This was spectacular. We saw so many animals/birds and learned so much. We saw many varieties of kangaroos, wallabies, wallaroos, and betongs (pronounced bah-tawns). We also saw parrots, bush pigs and all sorts of fowl. It was a great hike...no snakes.

That evening was another great night. All six of us had wine and brie on a huge rock outcropping overlooking the outback as the sun was setting. We had kangaroo steaks and corn over an open fire. And later we sat around and looked for shooting stars in one of the most impressive skies I have ever seen.

All was perfect until the Australian Blair Witch Project that night. I was fast asleep dreaming when something woke me up. Something was outside the tent making noise. All of a sudden it started bumping the tent. I was sure it was a dingo and I was prepared to tell the authorities how a dingo ate my Lindsay. But we looked out of the tent and there was a betong, one of the mini kangaroos. Lindsay laughed at me and we went to bed.

The next morning we got up at 5:45 and went on a 12K hike in the bush. It was great to be out there. We all had a nice time. We got back to camp, packed up and back to Townsville we went.

As I am sure is obvious, we had a wonderful weekend. We'll post a link to the rest of the photos soon.

We have a new home!

Well, it's official.  We signed a lease and paid the deposits this morning, and we are now the proud new tenants of Unit 323 Watermark.  Both of us awoke early this morning a little unnerved as we were anticipating some kind of disaster would occur.  But all in all the lease signing appointment was pretty uneventful.  We get to pick up the keys tomorrow at 9am, and then we'll make our fourth and final move in the afternoon.  What a long road it has been!  It seems like since we're just now moving into a real apartment that our time in Townsville should just be starting, but we've been here for 7 weeks already.  It's gone by so fast.  

Here is our address:

Unit 323 Watermark

72 The Strand

Townsville, QLD 4810

Matt had a crazy night last night at work doing the clinical coordination shift, which he described in an earlier post. Apparently they had a record number of emergencies in North Queensland and he barely had time to scarf down a sandwich during the 9 hours he was there. Tomorrow he does an "administration" shift (who knows what that means), and then he goes back to doing some clinical shifts, which I think he's looking forward to.  As usual I've been busy with work myself, but I am finally feeling as though I'm catching up on all the work that has accumulated over the last couple months.  My hope is that once I'm caught up (and I anticipate I should be caught up in the next three weeks), I'll have a lot more free time to do all kinds of things I've been looking forward to - reading, exploring the city, hanging out with our mates, writing letters, cooking for Matt (he not unfairly jokes all the time about how I can't operate a stove anymore), all that good stuff. 

I don't think there's really much else to report.  On Friday we are taking a trip with some friends out to Undara Volcanic National Park, which is an area full of lava tubes created from a volcano.  In fact, it has Earth's longest lava flow (tube) from a single volcano. It's about a 5 hour drive from here, and based on what we saw on Google maps it's going to be a potentially boring drive.  After we leave the suburbs of Townsville we only pass through one town (population 450) the entire 5 hours.  Hopefully the outback scenery will be relatively entertaining.  We'll camp both Friday and Saturday nights with our friends and head back Sunday afternoon.  

Matt's "Conference"

It's been another nice week in lovely Townsville.  78 degrees and sunny yet again.  Matt's job is still going well.  We hope to move into our permanent apartment this coming Wednesday.  We're very very excited to finally to have something to call our home away from home.  

Once again we met our mates at Molly's on Tuesday for trivia night.  Although it came down to the final question, our winning streak continues.  4 for 4.  This week Townsville hosted a cultural festival so after work on Wednesday we went to "Bollywood" night down on the strand to sample some Indian food and culture.  We also saw a great science fiction film (District 9) on Thursday.  We both gave it an A+.  Friday Matt worked in the evening but I went to my first Prawn Party.  Lots of fun seeing the friends we've made and meeting new ones.  Matt joined us around 11 after he got off work.  

This weekend was spent on Magnetic Island for the North Queensland Emergency Medicine Conference.  This was a conference in title only.  The first day of lectures included: 1) bariatric transfer 2) is life insurance a waste of money 3) xbox versus Wii.  Needless to say, Matt didn't spend a lot of time in the conference room.  In fact, 1 hour into the conference he snuck out the back and went with me to rent a moke.  A moke is a tiny version of a jeep and was a lot of fun to drive.  It was our first time driving stick with our left hands.  It really was an easy switch though.  Matt and I picked up a panini and a bottle of wine for a picnic at Alma Bay.  After that we went on a hike to the "forts."  This hike was home to a WWII military outpost.  The buildings are still on the hill.  This area is also home to a large wild koala population. We saw 2 of the little buggers sleeping in trees.  It was a beautiful day for a hike and we had a great time.  After that we headed to Horseshoe Bay for a beer by the water. Touring the island on the moke was awesome, and those of you visiting will have to do it.  

That evening we reconnected with the other docs over dinner at a great little bistro.  It was an interesting way they served the meal -  you didn't get to choose what you got, they just randomly placed a dish at your place and that was that.  The food was incredible so ultimately everyone was happy.  We left dinner around 10ish and some of us went to a local bar for a few jugs of beer.  It was great to get to know the docs that Matt works with and all seem really nice.  

The next morning the lectures were more interesting: 1) emergency medicine in Malawi 2) snakes in North Queensland.  I slipped in for the snake talk and found it really educational.  The snake dude (Eric, whom we met at dinner the evening before) even brought in two live snakes for show and tell.  I did pretty well despite the fact that one of the snakes was a Death Adder.  

After lunch we sat by the water and read our books and ultimately returned to Townsville on an afternoon ferry.  We just finished eating homemade veggie pizzas and watching The Black Hole, which is not nearly as exciting or believable as it was when we were in elementary school.  

This will be another busy week for us.  We move (hopefully) on Wednesday and we're leaving on Friday morning for a trip west to Undara, which is a national park full of lava tubes.  We'll be there through Sunday.

Just another day on the job

Part of my job here at Townsville hospital is to coordinate the transport of patients from rural parts of north Queensland to more urban centers where they are able to receive the care they need. Unlike my EMS experience in Boston where I helped to coordinate ambulance traffic around the city, in north Queensland about 95% of the transport is in the air. Today was a wild day.

North Queensland is big. About 400,000 square miles big. As a reference, Texas is a mere 260,000 square miles. The major cities include Cairns in the north, Townsville (my home away from home) in the middle and Mackay in the south. Just so you have an idea of the distance, its 830 miles from Townsville to Brisbane and 1275 miles from Townsville to Sydney. That is halfway across the US. Townsville is the only center in the entire area with any true tertiary services. The only things we need to ship (To Brisbane in the South) are burns and some complicated Neurosurg or Peds. Almost everyone else in north Queensland ships to us.

90% of the population lives on the coast and the remaining 10% live in small towns or cattle/sheep station scattered all over the outback. A small but unfortunately sick population of aboriginals lives throughout the area all the way up to southern Papua New Guinea. Apparently there is an agreement that Australia provides care for the residents of the Torres Strait islands which stretch from northern Australia up to “PNG” as its called.

This was my day….

7:00

Mt Isa

This is a small inland regional hospital 450 miles away that contacted us with multiple requests for transport. These patients had come in over the last 24-48 hours and now needed additional care.

1)A 65 year old indigenous woman with diabetes and acute on chronic renal failure. She had initially refused transport but was worsening

2)A NOF or fracture of the neck of the femur in a 58 year old alcoholic

3)A 45 year old woman with bilateral pneumonia and possible swine flu.

4) A 26 year old guy with bilateral empyema that was not improving.

5) A 56 year old man with a resolving STEMI after lysis.

When we arrived all had accepting docs but only the NOF had a bed in Townsville…so we started working on finding a bed for the others. Now to get to Mt. Isa it is a 2.5 hour flight each way and we can only take two people at a time, so we had to chose who was going to get a seat. We had a chat with the docs and compared the patients clinical scenarios (I was harping on vitals as I often do). After some discussion it was decided to take the STEMI and the ARF. The others would simply have to wait.

At this point we called up the flight crew including a flight doc to give them the details. They got set and took off about 25 minutes later. It would be about 2 hours until they arrive in Mt. Isa and 5 until they were back in Townsville.

8:15

Outside of Collinsville

From a town of about 300 people we get a scene call from a trauma. A 25 year old was pinned between a 4x4 and a fence. He was altered and complaining of chest and abdominal pain. The doc from Mackay had sent the ground ambulance, but it wouldn’t arrive for 45 minutes. We decided to send the helicopter for a primary retrieval simple because the mechanism sounded so bad.

8:30

Bamaga

This a small settlement on the tip of northern Australia. A 73 year old woman from one of the islands who presented with abdominal pain is getting worse. She showed up 3 days prior but refused transport. She now had a fever of 40, a rigid abdomen and a WBC of 32K. We got on the phone with the flight team in Cairns who quickly set off with a flight doc for retrieval. Its 3 hours by plane each way to Bamaga.

9:30

Mt Isa

The doc has informed us that a 26 year old woman G2P1 has arrived with BP of 180/110 and 4+ protein in her urine. She just moved to the front of the line. So we had to decide which of the two we were planning on picking up would have to stay. After consultation with the ED doc, renal failure would have to stay put for a little while longer.

10:30

Mareeba

A small town in the mountains northwest of Cairns. A 50 year old man on ace inhibitors presented with severe angioedema of the tongue and the GP (general practitioner) has never intubated a patient before. The report is that the patient’s tongue is filling his mouth and he is breathing at 25 times/min. Cairns is a 10 minute flight away, but their helo (helicopter) was off line for maintenance. After calming the GP down, we called the flight doc who happened to be an anesthesiologist and told him to go by ground….quickly. It is 1 hour each way by road.

11:30

Townsville

We ate lunch

12:15

Innisfail

A coastal city 1 hour south of Cairns. A 45 year old COAD or our COPD patient arrived with a GCS of 14 and pH of 7.1 and a Co2 of 111. After 2 hours on bipap his GCS is 7 and his respiratory rate is 7. Not good. He has not been intubated. The vent is broken. A spare vent is on the way. We start looking for ICU beds. Cairns says no. Townsville and Mackay are already over capacity. So we make the call to Brisbane.

12:25

Magically an ICU bed becomes available in Townsville AND the patient is intubated and on the spare vent. The only problem now is the doc from Cairns is in Mareeba with the angio edema, the doc from Townsville is somewhere over central Queensland on her way to Mt. Isa and the backup doc is not allowed to fly until 6:00PM due to fatigue regulations set by the state. We start working on finding a backup doc for the backup doc.

1:30

Bamaga

A 26 G3P2 with a history of rheumatic fever and mitral valve disease at 36 weeks presents to a clinic in active labor. The plan was for her to electively go to Cairns at 36 weeks to be monitored, but the baby didn’t want to wait. Unfortunately the only helo in the area is not available due to a search and rescue operation. The only other doc with any OB experience is on the main hospital on Thursday Island off the coast. Due to the active seas, the only way to reach it is via helo and I’ve already told you where that was. So after explaining this all to the GP, we basically came up with the plan to support her via phone as much as possible until 6 when the helo would be available and we could bring the other doc to help out.

2:30

At this point additional requests are pouring in but with ALL of our resources either unavailable or in the air, we are stuck. Most of the folks on the other end of the line seem to appreciate the difficulty of the situation. There are only so many aircraft and only so many docs. We make plans for the next priority when either the docs or the aircraft get back to base. I realized at this point, that sometimes the care one receives is more a matter of luck than anything else. If you get hurt or sick out in the bush and there is no mode of transport available you just have to wait. Rich, poor, aboriginal or white, you just wait.

Saturday August 8th

It's our first Saturday evening spent here in Townsville doing nothing specific. Matt is working until 11 so I'm manning the fort. It's not so bad though. I've managed to be productive and catch up on some work, pay some bills online, and even unpack a little. The new apartment is okay - not as nice as the last two places we've been in but it's cozy and really really big. And the shower is normal, too, so that's a big plus.

After we moved last night we went out for a late dinner on Palmer Street. The place was called Table 51 and had a live jazz band playing on the patio. We had a traditional Australian damper for an appetizer, which turned out to be a pretty basic loaf of bread. Good to try, but probably won't do a repeat. Dinner was a salad with coconut crusted bugs and pumpkin and artichoke risotto. Bugs, by the way, are a sort of crustacean shrimp-like food. The food, wine, and jazz were all fantastic.

This morning (Saturday) we got up and headed to the Billabong Sanctuary for a couple hours. The sanctuary is pretty rugged, as in there aren't paved walkways or big fancy signs or food stands everywhere, but interestingly enough it has a few swimming pools and BBQs spread throughout the park. So you can bring along a picnic and make big a day of it. All in all a very cool place. The highlight for me was getting to pet some small kangaroos. They're absolutely adorable and Matt had to pry me away from them. We saw a short crocodile feeding (very impressive) and a snake demonstration with a few taipans.

Not much else is going on really. Tomorrow is going to be a relaxing day for us. I'm having coffee with a friend in the afternoon and Matt and I will probably go to a movie in the evening. It'll be another busy week for sure. We'll work on uploading some more photos to Matt's Picasa web albums and send you the links soon.

The Little Things

This is arguably our most boring post so far, but I have several reasons for writing.

First, it's been awhile and I know how much some of you like to hear what we're up to even if it's nothing exciting.  And I'm sure good portion of you won't find any of this exciting.

Second, I have made a wonderful and amazing discovery, at least it's wonderful and amazing to me.  But first I should first give you a bit of background.  As some of you know, I am working from home.  My work station consists of my laptop and a bunch of accessories: my printer/scanner (which incidentally is a huge thorn in my side), my internet stick, a wireless mouse, and a large supplemental keyboard (the mouse and keyboard are critical because they're so much more comfortable to use when working on a computer for 8-10 hours straight).  However, each of these accessories requires a USB port and my laptop only has room for two.  So I have to pick and choose what I want to use.  Countless times during the day I'm pulling one thing out to use another.  If I need the internet (and I usually do), I'll pull out the keyboard.  And then the mouse goes out if I need to start printing.  Maybe this seems trivial, but I find myself constantly switching plugs all day long, and the printer plug always manages to find its way to the floor behind the desk, requiring me to crouch under the desk and blindly fiddle around just to get a hold of it.  It's a huge pain.  Trust me.  

Well, today Matt and I move again to a third apartment, but this time it's going to be our last temporary apartment.  I'm sure of this.  We managed to find a permanent place and we should be signing the lease for that today.  It's not available until the 20th though (and our friend Megan returns home from Brisbane this weekend), so that's why we're moving yet again.  I promise there is an end in sight.  

Anyway, this morning I took some procrastination time to pack up a few of my office supplies and stopped to dust off my supplemental keyboard.  I just so happened to flip it over and what did I see? It was a USB port hiding underneath one side of the keypad.  You can imagine the sheer joy it brought me to think that I could use not two but three devices at a time.  The time and hassle this would save me! Well, guess what?  There was a second one on the other side of the keypad.  Life couldn't be better.  

Now maybe you're thinking that I'm just a little bit of an airhead to have missed the extra USB ports to begin with, but in my defense I must tell you that they're extremely well hidden.  I'm just glad I discovered this now instead of six months down the road.  I'm so thrilled that despite the fact I have piles of work that are long overdue I couldn't stop myself from blogging about it.

The other reason I thought I'd write is because I wanted to tell you about two little everyday conveniences we have here in Australia that make me very happy.  The first thing is the switches on the electrical outlets.  I put a picture up so you can see what I'm talking about.  You can actually turn on and off power to the outlet.  So instead of having to pull plugs out of the outlets when you don't need them you just flip the switch.  A great energy saver in my opinion.  

The second thing I like - and pardon the subject matter - are the toilets.  There are two buttons, one big button for a big flush and a little button for a small flush. Obviously you know which button is for what.  This makes so much sense to only use the amount of water you really need.  Seems a waste that all flushes in the US are automatically big ones.  I'm not sure why the toilet industry in the US hasn't caught on. 

Anyway, I think that's it for now.  I should get back to work!

A Queensland Sunday Evening

Hello all,

     So sorry its been so long since we added anything to the blog.  A lot has happened so here we go.

     First and foremost I started work.  Yes you heard right I am now officially employed.  No one was happier to have me out the house than Lindsay.  I started last Monday and for the 5 days last week I shadowed the other attendings (or as they are called consultants) on the shift.  At least that was the plan.  By Friday I was attempting to run part of the department by myself with just a few pointers from the other docs.  

     I wouldn't call the transition difficult, however the waters have been a little choppy.  Although the medicine is essentially the same, the devil is in the logistics of providing the medical care.  One of the biggest hurdles I have encountered is drug names.  It sure seems like a minor annoyance, but it really can be confusing.  I told my first patient with an ache to take Motrin and Tylenol.  He had no idea what I was talking about.  So I had to sheepishly ask the custodian who was near by to help me with the name.  I'm sure that patient was filled with confidence.

The next big difference is that there are doctors and residents under me that can see a patient, come up with a plan and discharge the patient without every talking to me.  This is very very scary for a doc such as myself who has gone through the medical training process.  But this is how it is done.

     Lastly and probably most interestingly is dealing with some of the cultural differences in attitude.  For example, a 89 year old man arrives from the nursing home after hitting his head.  He is at baseline bed bound and demented.  In the US system, we have been trained to do a full workup including a CT of the head.  When I attempted to do this, I received resistance from all sides.  The residents and the radiologists both felt that since we probably were not going to do anything about it, a CT would be a waste of time and money.  What they are saying makes sense, its just hard to change practice so drastically.  We'll see how it goes.

    It was a crazy week for both of us.  Lindsay continues to be swamped with work.  Anyway, once the week was over, Lindsay and I headed down to Palmer St. for a nice dinner of Australian tapas and a mojito.  Afterward we moved to another place where we ran into one of our new Aussie mates.  We don't have that many mates, so to run into one on a Friday night says something about the size of the town.  We had a few VB (victorian bitters) and passionately discussed which was the more lethal in the history of Australia, crocs or coconuts. One other thing was discussed.  Trivia time!!!  Can you name the only two warm blooded animals that are also venomous?  Hint:  They live in Australia.  

      Yesterday morning we got up, got packed and headed back up the Great Green Way toward Cairns.  Two hours and 45 minutes later we just missed the ferry to our destination: Dunk island.  So we had a bite to eat and caught the next ferry.  We had read about this destination in the guide book, but as we pulled into the harbor past what appeared to be a replica of an old pirate ship, we were blown away.  It was beautiful.  It was a tropical island right out of Jurassic Park or Pirate of the Caribbean.  We grabbed our things and checked into our campsite in the middle of the rainforest.  The only other alternative to camping is paying $300/night at the one resort on the island.  We had a beachfront "room" and private beachfront dining for $10/night. And the campsite even had a nice hot shower and a complimentary wildlife safari.  Ask Lindsay about the spider.

  After getting the tent up and going for a little walk to "Muggy Muggy Beach" we took a bottle of Shiraz, some sandwich fixins and a variety pack of Tasmanian Cheese down to the waters edge, and had dinner while the sun set.  Really a memorable evening (especially since later I killed Lindsay while playing rummy in the tent).  

     Today we got up and took a 13K stroll to the top of the island and around the back side.  After a great fish and chips lunch, we got back on the ferry and headed back to Townsville.  

The housing search continues.  Although it is responsible and economically sound, Lindsay has given the thumbs down to living in a van down by the river.  I keep telling her at least we wouldn't have to move a fourth time.  Speaking of moving, our Aussie friend returns to Townsville on Sunday so we've got to move out of her apartment.  There's a good chance we'll be checking into a motel this coming weekend if we're able to sign for the apartment we want (which is available on the 21st).