Work Begins in the ED…aka Back To the Pit…

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 Paramedic..cool! 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…