Looking north, over the Bay

Sorry to be out of touch for the last 3 weeks or so…Lots going on…We have moved into a newer, bigger place, 24 Plymouth Court, in the Raby Bay Harbor.

Claire’s Welcome

…and Cate’s
Our pool by the canal

As rentals and homes in general are very expensive in Australia, we figured we may as well live by the water. It’s been really satisfying to watch the kids fish off the dock in the pre-dawn light; learning all about tides, boats and sea critters of all sorts. A very different world than Fairview Farm in New York state….

Yet another creature from the deep
Big A, in his element
Dr John’s silver rocket

Most rentals are unfurnished however. They even move out the appliances here. When it became evident that we’d have to outfit a house for seven, on top of everything else, Stephanie nearly broke down into tears. Luckily, the neighbors took us in as the Raby Bay charity cases of the year, and through their incredibly generous help and hard work, we furnished 60% of a four bedroon home almost entirely on donations, over a single weekend! We only had to lease a washer/dryer and fridge; but that’s so common here they did it in a few days, delivery, set-up and all set to go. In fact, they came and went without me even knowing they’d been here and gone!  You pay monthly or risk repossession, I guess….Voila, a new beginning!

“It’s a good thing…”(MS)

Here are a few shots of our first real dinner party, on a tableware hodgepodge of all the guest’s cast-offs and hand-me-downs. What a fun way to say thanks, complete with a nice selection of wines from Australia, Tasmania and New Zealand.. A most excellent time, and also a Bon Voyage of sorts to some new friends who are off to the wild west of Perth, working an off-shore Liquid Natural Gas play for a year or two.

Arrivals and departures

Getting kinda rowdy!!!

The girls, in matching party dresses…

So new beginnings, housewarmings and a Bon Voyage too, all rolled up in this amazing adventure called life. Rest assured we are well, and I have Critters and more Medical images coming soon…Best, by the water, ddu

Now all we need’s a boat..and a skipper…
Stephanie and her boy… a challenge no doubt…
Point Lookout Headland
Deadman’s Beach..don’t ask…

We took the ferry 20 miles east or so across Moreton Bay, out to Stradbroke Island , or “Straddie”, as it’s know to the locals. It’s one of several massive sand barrier islands offshore that protects the Brisbane area from direct blows by the open ocean. The outer beaches are famous for having miles of sweeping pure sand beaches, and excellent surf breaks around the rocky headlands. Only 2000 or so full-time residents, heavily wooded, and a feeling that you’ve stepped 50 years back in time on disembarking. It’s very beautiful and laid-back, even by Aussie standards, which means very… We were lucky in seeing dolphins, sea turtles and a manta ray, all on a single day excursion.

Nolan Hat Party
Cate and Aidan at sea

Aussie Surf Rescue Club

It’s remarkable how attuned to a life around the sea these coastal Aussies are. Every beach has weekend Surf Rescue clubs, and at Main Beach on Straddie we got a close-up glimpse into their training and upbringing through the ranks to attain full rescuer status. As a clarification, these outer beaches are what they call high energy coastlines, and as a life-long New Englander/ Bostonian I thought I had a pretty good idea what that meant. Not. On a calmish day these beaches have onshore winds of 10-15 mph, 5-6 foot waves and surf that can get choppy and disorganized. The waves build fast and break quickly, aka “dumpy” waves. Not the long rolling, evenly spaced crests that are ideal for surfing; those generally occur at very specific points around headlands,….Bathing on these beaches is somewhat more akin to Maytag: spin-cycle; and you can get thrashed if you’re clueless, or drunk, or otherwise not paying attention. They rescue lots of folks, all the time…
Even more remarkable then, to see teams of 6 and 7 year olds (nippers) suited up and swimming relays out 50 or so yards through the breakers and around a temporary buoy, then racing back to shore. After 6 years of regular drills they then advance to junior lifesaver status and need several more years to become a full-fledged adult Livesaver. As these drills are playing out, older kids are patrolling offshore on jet-skis and Zodiacs to pluck up anyone caught in a rip. They ride the surf like rodeo cowboys. Meanwhile, Moms and Dads socialize at the tide line while toddlers, 2-5 year old boys and girls, are being tossed around by breaking foam like so many scrambling sandpipers. Just another saturday morning at the beach…Truly, a life defined by and very deeply attuned to the sea.

Nippers heading into the breakers

Luke out, nippers forward…!
Surf Breaks, Point Lookout
The ferry home to Cleveland
Don’t hate me ’cause I’m beautiful…

As a bonus tonight , for your loyalty as regulars to ddu, I have a special treat, unrelated to the sea.. Behold , the lowly, but infamous Cane Toad! Not native; a transplant from Indonesia or somewhere, brought in to eat the bugs in the sugarcane fields. But now sadly, run amok. Looks and acts just about like any old toad..but notice carefully the large venom sacs just behind the eyes. Full of venom lethal enough to kill your dog in minutes, but only if Fido is really asking for it.. Otherwise, you can look, but you better not touch…Another oddity in a long line of such…I will try my best to dig up a few more for your entertainment. Tonight, just be thankful if you have regular old garden-variety toads in your gardens at home.  They really are your friends….Best, ddu

Venom sac close-up…Mmm, tasty Fido…
In my element, a modern ED

Looking over past posts, it seems that I’ve neglected somewhat the whole point of our being here, which is to help deliver high-quality, world-class EM care to the local population. The US is at the forefront of EM training, and as a proud graduate of Boston City Hospital’s EM class of 1994, seven graduates in total, now with some 18 years of experience behind me, I’ve seen a lot; good, bad and atrocious. I’ve gained that most valuable of commodities, perspective. I have to say, Queensland Health has been great to us, delivering on all promises. The ED at Redland Hospital is larger and more progressive than expected. The area is growing rapidly, and as the penultimate service industry, so is the hospital.

This thing rocks!! The modern stethescope..

For all you Medical Systems wonks out there; we have a dedicated Radiology suite, a 64 slice GE CT scanner, with a Fufi Synapse PACS just being implemented. Cool, as it’s the same system I’ve been using in NY for the last eight years. Lab is spotty with I-Stat bedside testing done after hours for basic stuff. Critical labs are still couriered into Brisbane! As in many non-tertiary Hospitals, sub-specialty coverage is spotty, to non-existent, and limited after hours. We have general surgery for elective stuff, but no real after hours emergency surgery. So, less sub-specialty coverage than in the US overall.

The next generation of life savers?

Due to a lack of Ortho coverage, and potentially delayed Ortho clinic follow-up, it’s typical for EM docs to do definitive fracture reductions in the ED by means of the ingenious Bier’s Block. This is a historic footnote in US EM training programs; but basically you elevate and blanch the affected limb, apply a double tourniquet above, and inject a lipophilic, short-acting anesthetic agent into the limb, generally Prilocaine. Within 10 minutes or so you get a dense regional anesthesia to said limb, and curiously, you can bend and twist and pull outrageous amounts of traction on a little old lady’s arm to get the reduction, while she sits beside you smiling the whole time… It works well, avoids airway and breathing issues and wears off quickly. Lawsuit city in the US, but a practical adaptation to local realities in most of Australia. One interesting side note is that it’s critical to use a short acting, lipophilic agent, and keep the tourniquets up for a minimum of 25 min. post-procedure. This allows the anesthetic to fully bind and redistribute into the fat and be neutralized. There are case reports of brief procedures and early deflation causing a massive rush of anesthetic back into the patient’s central circulation; end result being a cardiac arrest, aka “lawsuit city.”

A Bier’s Block, post reduction and splinting
No longer a room, an Emergency Department.

20 acute beds, 5 short stay and 6 walk-in. And growing.

While the quality of care is generally high; as in the US, the healthcare system is straining under almost unlimited demand, lack of capacity and disorganized healthcare delivery and records. Being a primarily government-funded system, though with a surprisingly large component of privately insured patients, and lacking the aggressive cost-containment demands of a US-style private insurance industry, Australia is at least a decade behind the US in terms of implementation of robust electronic medical records (EMR) and charge capture.

Our future challenge….

As in the US, care for the aging, more chronically ill patient population is consuming an ever larger portion of HC spending. When discussing the future of EM care delivery with the junior residents, I stick with Dr. Nolan’s pithy, four word adage, “Older, sicker, poorer, fatter…” That about sums it up people, a neat encapsulation of the challenges ahead. 

Wishing you become none of the foregoing, at least not too soon…  Best, ddu

Redland Hospital courtyard