Tales from the Big Smoke…that’s not a cigarette in his mouth…
Tonight I thought I would broach a subject that might be somewhat uncomfortable for the non-medical, uninitiated in the audience. A primary purpose for our coming to Australia was the chance to practice Emergency Medicine in a foreign system. It was the reason I was recruited by Queensland Health; and my advanced EM training is what made the whole trip possible, right down to the working visa. As a condition for gaining my FACEM, or Fellowship in the Austral-Asian College of Emergency Medicine, I am required to do a six month, part-time stint in a Level One, Tertiary Trauma Center ED. As scary as that sounds, I spent 3 years in a much worse ED environment at Boston City Hospital in the early 1990’s. So, a homecoming of sorts…
The PA, a modern 700 bed Tertiary Medical Center

The Big Smoke….indeed
It’s hard to know exactly how decisions made years ago dictate your life’s pathway, but mine has led me into the somewhat arcane, and highly specialized world of modern Emergency Medicine; a place where even many seasoned physicians find themselves uncomfortable.
Rooftop Helipad with elevator. Bad things incoming…..
Extra recuscitation “stuff”
But it’s my world, and these are my people. I get the jokes, understand the veneer of fatalistic cynicism that ultimately shields one’s inner core, and feel strangely at home, and even enlivened, by the steady stream of the bizarre, the grotesque and the tragic played out daily in the ED.
Main ambulance bay, early morning, pre-gridlock…
Doorway detail
An old Australian expression for the Big City is the “Big Smoke…” The Princess Alexandra is every bit that. As the Level one Trauma Center for the entire southern half of Brisbane , pop. 1.5 million, it takes in all the critically ill, trauma and multi-system failure patients from SE Queensland, around 65,000 patients a year. It has full USA level multi-specialty backup, and is one of the major teaching hospitals in Australia.

Greetings from Brisbane Australia!

Bribane River and City Cat ferries

Downtown Brisbane from Kangaroo Point

Meanwhile, back at the PA
A clean, well lighted place

Standing By…and then…

First morning, first patient….

Of course, on my first clinical day, I walk in at 0745 and everyone’s in one of the five trauma rooms. A male bicycle rider vs a truck. Truck wins, every time…..I don’t want to upset anyone with the graphic details, but I spent the morning lead-gowned as an observer in the Interventional Radiology suite watching them coiling hemorrhaging mid-face arteries.. Though I was a complete stranger, the Aussie crew couldn’t have been more professional or accommodating; even allowing me to shoot pictures of them busy at their life-saving work….And what an amazing privilege, to be allowed a glimpse inside their fascinating environment…. Here are a few shots, while still trying to keep it family friendly…

CT 3D, Lots of facial trauma if you know where to look…
Prepping the patient for angiography

Interventional Radiology,

The trauma team in action

Nice to have on your side when you need it…

Who’s gonna lift that bandage…?


Right mainstem bronchus ETT with whiteout on the Left

For the Medical people following along, I have to say, it’s been a wonderful and humbling experience to be back in the Tertiary world after 20 or so years.. I’m one of the “senior” team members now, but everyone is extremely helpful; and luckily, they aren’t expecting me to run the team. Unless I want to, of course…! Teaching Residents again has been very rewarding; I have seen a lot over 20 years it seems……The clinical conditions are similar, but the management has changed somewhat. We are using lots of pressors, Adrenaline and Noradrenaline (no “Epi” down under!), Propofol infusions, lots of Ketamine, even in adults; auto-infusion devices..But no Dilaudid, IV Benadryl, Lorazepam or Quinalones…Ultrasound guided everything..central lines, arterial lines…Very high acuity, very invasive and intellectually challenging for sure! And the 64 slice scanners with near instantaneous 3-D reconstruction provide very rapid confirmation, or humiliation of your clinical diagnoses…

Below are some random images of fascinomas and curiosities I’ve encountered thus far in Australia, most from Redlands Hospital. Probably no stranger than a thousand other ED cases around the world, but a glimpse into my ED world in Australia…enjoy! PS: all patients gave me their express permission to be photographed and have their images used for teaching and blog purposes, so no worries about patient confidentiality mates…
? spider bite in Papau New Guinea, 3 days old…

Sebaceous cysts

Rugby blow, see free air around R orbit..?

Good leg, bad leg

Finger nail…haha..get it??
Finger nail #2, with open fracture

Swallowed a bone..see arrow….

Skin graft, failing…

Flipper foot; rare congenital deformity, only two toes etc…!

Very bad legs…

Rheumatoid Arthritis #1

RA #2

Dead Toe

Chest tube detail

Breath of Life

Critical, intubated
Back of the Bus, on the road again…

Critical Transport, QAS
Ankle reduction, procedural sedation
Pleuricentesis detail
Success! 1700 ml…

Bier’s Block, fracture reduction

Intracerebral Hemorrhage…always BAD…
“Belt Burn” boobie, car accident
QAS at Redland Hospital ED

…and now a psychic pause…

 I hope you’ve enjoyed the whirlwind tour through this major part of the Aussie adventure. I think that it’s reassuring to know that throughout the world, there are emergency professionals standing by to assist 24/7; in fact right now, in every major town and city. Not generally recognized or even acknowledged by the public, but standing ready all the same. My people…Give them a thumb’s up for me please.. Until next time, stay safe and healthy.. ddu.

The Brissie eye…

Southbank Brisbane

Morning harbor

Last week’s blog seemed to be a big hit, so today, more fish tales…. We took a charter out into Moreton Bay and had an amazing day of inshore fishing. The bay is an enormous biosphere reserve, 60 miles or so long, that’s protected from the open ocean by offshore islands. They keep things generally calm and easy for boating and sailing…There aren’t open ocean pelagic fish, but instead a diverse variety of mangrove and reef species that come and go seasonally….The weather, tides and fish all cooperated to make for a great day.


Out to sea….
All fishing is local, so it was great to have Sean to show us lots of local secrets and techniques to catch some fish. The tide was just changing from high to running out as the sun came up. I caught a nice snapper on the very first cast. Now that’s insider knowledge at work!
Another keeper
Aidan hooks up
A “chopper” Tailor. A winter schooling fish. Called a “snapper” Bluefish in the states
A nice pan-sized snapper
Mark and Sam with a weird Shovel-nosed Skate. Not a shark…
Aidan, Sam and Luke…Fishin’ Buds….oh, I mean “mates…”

Local bait

Sean passing on the knowledge
It’s early winter here in Queensland, so the schools of snapper are just coming into the bay. Although they can get quite a bit larger, these 40 cm pan snapper, 1-2 lbs, are perfect eating sized, and put up a surprisingly tough fight on light tackle. The boys, and I, were in heaven out there…

The tide turned and started running hard, and the fishing dropped off suddenly…Sean then took us down into the mangrove channels; casting rubber baits along the deeper cutoffs. Luke hit paydirt with a nice 63 cm flathead, or “lizard” as they’re known locally. A bit ugly, but considered a delicacy at table..

Catch of the day, a nice Lizard…

A great fish Luke…!

A wonderful day afield with my sons

 I also managed to land a small sole that struck the large soft bait three different times before I got him.

Bait prawn

Just looking for a handout…
We also saw lots or birdlife, including curious and hungry pelicans, and though hard to photograph, sea turtles surfacing regularly. In the end, they day came to a mellow close. A perfect day spent immersed in nature, on the water with friends and family. Learning lots of local lore and techniques. A big thanks to Sean at Moreton Bay Charters for being a great guide, mentor and host. We highly recommend looking him up and setting up a charter…

The shirt says it all
Heading home

Sean, the skipper

After getting home, still lots of work to do cleaning the catch; but a wonderful grilled snapper dinner awaits. The icing on the cake of a perfect day.

Lifelong memories of fishing with mates…

So, thanks for following along on yet another Aussie adventure. I am now working parttime at the Princess Alexandra Tertiary Level 1 Trauma Center in Brisbane. Next up will be some fascinating EM shots and tales from that otherworldly environment. A real window into another aspect of our life in Australia. Stay tuned..Judicious editing guaranteed…..ddu

PS: More mud crabs, caught on the scraps of snapper