Aussie Surf Rescue Club

Tonight’s musings will extend on my last post concerning beauty and danger… and their sometimes uncomfortably close proximity. We had the weekend off, beautiful weather, so decided to take a short 20 minute ferry hop over to Coochimudlo Island, noted for it’s beautiful sand beaches. And it was beautiful; hot, sunny and laid back. Seemingly a world away from the mainland just across the strait.. Kids all ready for a swim…only not so fast.. It seems an unusual combination of wind and tide had washed a large blossom of stinging jellyfish into the shallows.. Not the truly deadly “sea wasps” of far northern Queensland, but capable of delivering a sharp sting from the sea nonetheless.. Hmmm….. The local lads were having a fine challenge trying to scoop them in their hands and throw them onto the beach, but were getting more than a few stings that they tried to laugh off.. The local surf rescue club was netting them into gelatinous piles of the softest blue.. Of course Luke and Aidan immediately began spearing and shredding them apart with sticks…” Better than swimming , Dad!”  Within minutes Luke flung one ashore in a spray of wet sand and jellyfish particles, hitting 3 year old Owen right in the face.. He, quite understandably, erupted into a howling tirade that alarmed even the surf rescue crew and got their attention with ice packs and a cold bottled-water eye irrigation, done by yours truly, ddu, right there on the beach…Thanks Luke…After an hour or so the screaming wound down into a piteous, fatigued weeping and sleep; we settled back into our tropical idyll…

Up for a dip? Look closely….

(In a post script on that disaster, as an act of brotherly revenge, Aidan thought it a funny idea to drop a jellyfish into Luke’s bathing suit, I’m not kidding…though he insists it was one of the less toxic clear ones…Luke spent 15 minutes rinsing out his “nerds” under the public water fountain in the local park.. You really can’t make this stuff up…..I swear!)

Satan’s bouillabaisse

As the afternoon slipped away, another unexpected danger made its presence felt in the unrelenting intensity of the southern sun at midsummer. Wonderful to bask in initially, but very soon overwhelming at height of day, it really is a physical force to respect. In the ED, as Cleveland is a growing retirement area, I see the almost unimaginable skin damage done over a lifetime of pale Caucasian meets the Sun King, in the pre-SPF 50 era. These guys and gals got cooked, plain and simple. As the votes, though meager, seemed to support showing some medical images, here’s a first, taken and used with his kind permission. The red facial lesion is a Basal Cell Carcinoma, partially resected. Note the dog-ear, from past similar excisions. Slather up people…!

Chillin’ and Grillin’, it’s the future Mr. Melanoma…
A long life in the sun

That very same evening, the boys and I went out fishing on Cleveland Point. There’s a beautiful old wooden lighthouse , a small, manicured picnic park and the Lighthouse (duh,,,) Restaurant that serves wonderful homemade Sorbet and Gelato. As we were walking into the shadowy park, happily licking, a man’s voice interrupts, ” Excuse me, if you are walking into the park.. watch out, there’s a snake right over there..” He came over with a small flashlight..seemed rather authoritative about such things….”That’s not a python (large, but harmless), I think it’s an Eastern Brown ” ( non-descript, but potentially deadly). Well that caught me totally by surprise and burst my sunshine-lollipop state of mind for sure….! I tried to get a few quick cellphone shots in the semi-dark by light of flash, while keeping my distance…see below. Even creepier, the snake meandered over under one of the small picnic pavilions and was last seen curled up at the base of the BBQ grill…. We told a few people, but left feeling like we should have set off the nuclear snake alarm or something. Especially scary as this wasn’t out in the bush, but right in a heavily trafficked area…..So Beauty…and Danger…. close cousins and role-shifters in the land down under….More later, snakes willing..! ddu

I WILL ruin your picnic…..
Luke’s Catch
Another gem from the sea..released…
We have been getting out and about, fishing, hiking and learning about this always fascinating Continent.
Everything of interest always seems to turn out to be more interesting, more surprising and intriguingly odd than expected…..SE Queensland is much more vast and diverse than imagined. The contrasts can be truly startling.

Paragliders on Tamborine Mountain
A leap of Faith

Not your friend…Seriously, not…

Malevolent appearing spiders give way to fragrant blossoms, only yards away…But you really should watch your step…
Many more adventures to follow. Hope you are enjoying the trip…Best, ddu
But then beauty, around the next bend…

Sorry to have been a bit out of touch. See, reality intruded, and I actually had to begin work in the ED (that’s Emergency Department henceforth, no, not erectile dysfunction dirtyminds…). As I stated at the start of this blog, being ” Doc” downunder, there is a medical component involved. Fair warning to the squeamish, wifty or otherwise easily offended, there could be some graphic photos of medical cases ahead..In fact, I’ve already got a few good ones, but Stephanie said I shouldn’t post them. Show of hands, or clicks, from the loyal readership…Anyone want to see that sort of stuff…?? I’ll hold off, pending comment. Also, I will be using ED medical shorthand somewhat when discussing particulars, just in the interest of getting through it all.. If you feel lost, you can just skim over and look at the pictures! Or, not….So, EM (Emergency Medicine, the discipline, not the place; that would be the ED, see above…we practice EM in the ED…everyone got it..good..carry on…) in Australia.

Dr Nolan’s first day of school photo. So innocent…!

Finished my first round of 4 ten hour shifts as a Senior Consultant. The ED well equipped and modern. Very well-staffed by US standards, but busy. I round with the charge nurse and keep things flowing, beds turning over and transfers/ admits all heading in their desired directions. Beyond the clinical, or medical component, patient flow management is an art in itself. The charge nurses here know the system and get it done.. I mostly tag along and add my two cents now and then. Junior doctors run cases by me and I advise and teach procedures like complex suture repairs. The Australian training system post-Medical School is really Byzantine and not as Residency goal directed as in the US. Many of the Senior Medical Officers (SMOs) are not in an active training program, and never will be. They are career house officers and can be in the same position for years, but never attain Board Certification. On my third shift I was running a 20 bed acute side with a team of 6 junior docs. My “mentor” Rogash, who’s coming from 4 years in Melbourne and is Residency-trained, has been in this ED one week longer than me. So, basically, the blind leading the naked…And it was busy; trial by fire, jump right off the deep end, whatever…. Thank God for senior nurses! We got through the shift without a hitch. Mid- evening on my last shift we had a 65 yo F come in by private car having a big heart attack (Inf-Lat STEMI, Q’ing out) really sick and unstable. I hadn’t even had a chance to review the STEMI protocol yet, but there I was, talking to the Cardiac Interventionalist at the Tertiary center, Princess Alexandra Hospital (PAH) 25 min. away in downtown Brisbane. We thrombolysed her and got her on a waiting ambulance. The ED staff is like, ” OK Doctor Nolan, are you riding along with her?” “Whaaat…?” It turns out the paramedics here don’t transfer really sick patients without a doc on board, and except at the highest level, the drug box doesn’t travel with the ambulance (a fine time to tell me all this…). So scrambling ensued to grab an EMS/ACLS mobile pack complete with airway management gear and ACLS meds (that I also hadn’t had time to review). ” No worries, mate..she’ll be right…” So, for the first time in my 20+ years EM career, I’m in the back of an ambulance, adjusting a Nitro drip and setting up the pacer/ defibrillator for action, as we careen through the darkened streets of outer Brisbane lights and sirens, rolling through red-lighted intersections; getting to the PA STAT.. . It was all very exciting, the patient went into an accelerated junctional rhythm (bad) and began to degenerate on arrival to the PA. Met there by the assembled cath lab team and off she went to definitive care. I got a very nice tour of our upstream Tertiary ED by an EM Attending named James, and then got left out on the sidewalk alone, by the ambulance squad who had other places to be.. Called a cab for a ride back out to Cleveland, got him a voucher and finished up just as my shift ended at 2300.. 

An ED doc, and a mobile! Outside the PA ED.

So, a real life saved, a quick tour of inner Brisbane by ambulance, and a ride back out to the country.. All in all, a pretty nice day’s work…Sorry about the lack of good photos. Honestly, I was so disoriented and excited that I forgot entirely. Better next time I promise. It’s going to be an interesting year! Stay healthy, watch the weight and please, don’t smoke…best, ddu

This ride looks serious…