Smells: Our Week 3 Review

If the theme of Week 2 was “Bugs”, the theme of week 3 was definitely “smells”.  Funky odors and sickening stenches are something that you learn to expect as you go through your theory courses about diseases and patient care. From gangrenous toes, to dirty diapers and freshly removed casts.  But, you really can’t prepare yourself for their assault on your crista galli. And mine just happen to be abnormally large or something, because I am always affected by the scents wafting around not only the hospital, but the house and the sidewalks and, well, everywhere.

I love picking up new terminology at work and deciphering the Doctor’s impossible scribbles- things like Sjogren’s Syndrome, and Perthes Disease, Charcot Fractures and FOOSH (fell on out-stretched hand).  Things I’m not particularly thrilled to learn about are flautus-tubes.  Yes – they are exactly what you think they are: tubes inserted up the rectum to relieve pressure built up from things like blockages, impactions, or volvulus – like the patient I started my week with. It really makes that connection with that partially inflated bag poking from beneath the sheets that looks less than pleasant.

At least flautus tubes (I can’t say that without picturing it in Hank Hill’s voice from “King of the Hill”) keep the aroma’s contained, however.  Unlike the other patient I met who we were seeing due to extreme distension and abdominal discomfort. I’m not sure that they spoke English, and they groaned from the time they were wheeled in the room. To make things worse, we had to use a sliding board to transfer them on to the x-ray table.  You may be able to see where this is going…I’ll just say it was questionable whether what was squeezed out of her during the roll was physical or atmospheric, but it engulfed the room.

For the first part of the week, this seemed to be the theme: bowel distension, recurrent volvulus, incompetent diarrhea, but oh!  There was more to come!

I really shouldn’t have asked what it was, but I couldn’t help it when I saw the words “feculent vomiting” on the request form. It couldn’t possibly be what it sounded like?  Oh, but it is!  I made a face before coming out from behind the window to help move the patient. Lo- and behold, first came a phlemy-sounding cough, and then he let loose almost before we could hand him and emesis bag.  I quickly turned away, and had to slyly slip outside.

I wasn’t let off that easy, though, and by quitting time on Thursday, two more patients had chucked up their insides, one I thought for sure was inside-out by the end of it all by the sounds of it. 

Between all that, I came face to face with an assortment of feet who take the cake when it comes to “smelly” – whether they be ‘dry and scaley’ scented, or ‘diabetic-toe-amputated sweet’. I was also assaulted by a couple of extremities who were getting their first breaths of fresh air cast-free after 6-8 weeks.

Sweat-soaked sheets, caked-on bandages, seeping bed sores, soggy adult diapers, seeping cavity drains and catheters, weeks-old unbrushed breath, and feculent-vomit filled trash cans:  we truly took a trip down the ol’ olfactory lane this week… and we haven’t even made it to the ED yet.  Oh boy, I can’t wait!

Letters to Mum

I had an epiphany as I whooshed off an email to my Mum back in Cali.  It painted a pretty good picture of our life here so far, and for some reason, addressing a specific person made it a bit easier to spell it all out.  So, I thought, why not share it with the rest of you as well?  You all probably wonder about the same things!  So, maybe I’ll make it a regular thing?  Let me know your opinion!

Dear Mum,

We’ve made it through our first couple weeks now, and getting to the end of #3.

It has been incredibly busy, and will definitely take a while to get used to:  I have never been on my feet for so long so many days in a row - it is EXHAUSTING!  

Houses here don’t have central heat, and it gets awful cold at night.  So, when we wake up at 5, it is freezing cold and incredibly difficult to crawl out of bed and run to the bathroom.  To make it worse, our bathroom is one of those fancy modern ones that doesn’t have a shower curtain to keep the steam in! Then, you finally get a little warm, and have to run back to the room in the freezing cold all over again.

Then, after cleaning up and grabbing breakfast we either walk in the rain and the dark to the bus stop, or lately, bless his heart, Michael has been picking us up and offering a lift to work.

We arrive around 8am, and switch on the machines and boot up the computer, preparing for the department to open around quarter-to. That’s when we start with the "wardies" (in-patients or 'ward' patients) and go through in- and out-patients all day long.

We get a ‘morning tea’ (a 15 minute break) and an hour lunch, and get off around 5pm. Lately, a few people have been kind enough to offer us a ride home, and we usually get out of the hospital and make it home around 5:30 or 6pm.

If we take the bus, we get home around 6:30.

For some strange reason, most of the stores close at 5 or 5:30 during the week, and since it’s winter, it dark again by this time. We are often too tired to cook, so we get take-away, sit down to eat around 7pm.

By the time we eat, wash up, catch up on news, and possibly check the email, it’s after 10pm, and we pass out. Chad’s still a bit sick, too, so neither of us have been getting the best night’s sleep.

We are learning A LOT though, and getting on with most everyone pretty well. There are a couple people, of course, who have personalities that clash with me, and same for Chad (often people that we disagree about - ones I like a lot that he's not too keen about and vic versa) but I already feel like I have learned more than I could have imagined.

We are still in "general" right now, and we just got our rosters for the next 8 weeks. I am moving to the “private” wing of the hospital next week, and Chad is going to ER.  I can’t wait!!

We are about as sick of public transit as can be - we got all mixed up with buses one night last week and didn't get home till after 8. Needless to say, we were both grumpy and tired and hungry and GRUMPY (:  Not fun.

You asked what we missed most, and there are a few things.  One is my own transportation.  The other thing, however, would have to be prices and store hours.  I can't stand that most everything here closes so early - even on weekends.  For some odd reason, Thursday night is the "late night" here.  It was explained to us that this is because Thursday is pay-day. This makes shopping incredibly difficult during the week - if we run out of bread or eggs, or are missing an ingredient for dinner, we are basically SOL.

 I miss costa vida, and el pollo inka, canned black beans and green enchilada sauce.  Chad misses cheap Dr.Pepper (it's $2 a 12 oz can if you are lucky.  $3 on average). There's no dollar menu's here either.  Also, this country is severly lacking in the BBQ department - which is another thing I greatly miss: our BBQ grill! The things I love are the possibilities ahead of us.  There are lots of places we want to see, and lots of "weekend" trips we are starting to plan.  I also love learning all their terminology here, and how their daily systems work - like the hospital layouts, financial years, school systems, etc.  There is so much it is hard to explain! I also love the fact that we actually made it here!

  I miss you all – give the family hugs from me!

M

BUGS: Our Week 2 Review

Week two- our first FULL weeks – 5 days- of work.  The dreams of calculating the wrong techniques, having 7 repeats on an infant, x-raying the wrong patient and not even realizing it, and being ripped to shreds in our first review are starting to subside.  I’m starting to feel like I can handle this.  I’m starting to take pride in how much I’m learning. It’s a good feeling to take an image your’re really proud of!

Being on “Level 2” – where general x-rays are taken – has given us a good introduction to both Flinders and the work.  We see in-patients – the patients in beds or wheelchairs that require routine images, or follow-up images, as well as out-patients that just need follow-up xrays of their broken arms, legs, toes, etc.  We aren’t faced with patients first presenting with their bones poking through their skin and swollen like shiny pomegranates.  That comes later, on “Level 3”.

The most striking thing that we’ve been introduced to on Level 2, however, is the prevalence of “Bugs”. Not the common cold, or a bit of rhinitis, but the scary ones:  MRSA, VRE, and even a touch on Dengue Fever!  You take for granted that you’ll be dealing with these things at some point in your career at a hospital, but in Australia these things seem to be a bit more prevalent. We get patients with these bugs on a daily basis.  Multiple times.  We down colored gowns and glove up.  We cover our films and practice our “clean & dirty” tech routine that we were taught at school. We are careful about where we touch and who moves what, and disinfect everything with “tuffies” once they are gone.  Sounds standard, of course, but in school they didn’t prepare us for how often we will be gowning and de-gowning, and how often we will be seeing these patients.

As we make our nightly trek up to Michael’s office on level 3, we get our preview of what’s yet to come for us in the ED (or ER as we call it back home):  Man with Dengue Fever, a nurse bustling in to the room to let the techs know that the next patient has everything you can imagine – kindly rattling off a few to make her point: “MRSA, VRE, SARS, Scabies, Malaria- probably even Ebola”.

Ok, so Ebola might be a stretch, but we must joke about it in order to cope with the fact that we are constantly surrounded by these sometimes petrifying diseases.  Michael explained to us that because of the climate here, and because of the migration of folks from the Middle East and Africa, there are a lot more cases of tropical diseases (like the Dengue Fever I mentioned) and others that are rare in the states. Hell, they even have the Hendra Virus here!  (Horse Flu for those of you in the States)

With each new week, I’m sure we will continue to encounter new patients with interesting health histories, and learn about brand new diseases that we’ve heard of but never really known much about.  It comes with the territory, I suppose. Something to bring back to the states with us J

Night at the Laboratory

It was hard to not be a little suspicious when, with a grin on his face, Michael said “ I have a deal for you”.  A room in the basement of the hospital had recently become available, and together Michael and Liza had devised a plan to turn this room into a “student louge” area – a place where we could do weekly teaching groups and presentations, as well as study, hang out, and store our books and bags.  In return for helping to move some stuff around, Michael would give us a ride home.  At $5 a bus ticket home, and nothing else to do in our lives outside of work, this sounded like a fair deal to us!

So, the day came to a close, and here came Michael, grinning away about this room.  He was thrilled to get it completed, and was already looking forward to impressing Jenny when she comes out to see the hospital.  He handed us each a yellow gown, the ones we wear for exams involving communicable diseases or highly contagious pathogens. “It’s not a real dirty job” Michael says “But, just to make sure you’re clothes don’t get dirty”. At first I think he’s kidding.  He’s not.

We made our way down in the elevator to the basement – a cold concrete maze, lit with fluorescent bulbs.  He shows us “the cage”, a chain-link enclosed area where the stuff that no one really wants to deal with is stored.  And then he shows us the room we are to clean; the stuff that we need to move to the cage.

He told us that this was the same area that his CI had taught him years ago when he was a student, and that his new office was his old CI’s office – a sense of nostalgia about it.  What he had failed to tell us was that the soon-to-be student lounge was in fact an old research laboratory, whose occupant was – it appeared to be- a mad scientist who did research on rat brains and took off in a hurry, leaving all sorts of bizarre things behind.

After getting past the “gross” factor, we got to work, cleaning out this man’s life work.  It was like going through an old medical museum and you know what?  It was absolutely fascinating!!

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We found thousands of slides of rat kidneys, brains, and eyes – mainly brains.  We found a tissue sample, yellow and degrading in a jar of formaldehyde (What we came to find out was an ethmoid bone and pineal gland). We found thousands of pipettes, beakers, and old laboratory equipment. Ancient, yellowing bottles of contrast, a bizarre primitive respirator device, covered in – what else? – rat hair.  An old blood pressure gauge, and my favorite – old doctor headbands with the little round mirrors on them!!  A nuclear radiation containment device, an old scale, a prehistoric surgery light, and an ancient centrifuge.  A microscope that probably hasn’t seen specimens for 2 decades. 

It was quite difficult to stay on task – it was ridiculous to think that all that stuff was still in tact – to imagine that some of that stuff should honestly be in museums! 

Michael told us a bit about the man that had done the research there, and we deduced that the work we were seeing was what had led to some blood-brain barrier breakthrough he had made.  Bizarre, eerie, a bit disgusting, and fascinating.  We took so long that Michael threw in dinner before following through on his end of the bargain and giving us a lift home.  But at the end of it all it’s hard to say who got the better deal?  I’d say a Theo’s café chicken sandwich, a Solo, a lift home, and a journey into the crazy mind of a scientist’s life work was well worth it!!

Elvis Impersonators

It was something I never would have expected, hopping off the train and crossing the tracks to the main road.  We passed Henley Beach Road, reminiscing about our Henley Kitty back in Oregon, on our way to the Uniform shop for our Hospital Uniform fitting.  I looked up the street, squinting, not really sure I was seeing clearly. But, as we got closer I saw that yes – it was a raptor. Holding a between it’s dino fingers, I read “WATCH OUT!  Momma raptor isn’t far away!”  I couldn’t help but stop at stare at it, thinking wtf….

Just inside the large, open-arched doorway of the shop was an even larger, animatronic t-rex, flailing its stumpy little claws around and blinking its yellow eyes with a clicking sound.  Looking past it I saw a scantily clad pirate woman statue, a shark, a Chinese foo-dog, a wall covered with any type of doorknob or handle you could imagine, mirrors of a million sizes, and an enormous fountain in all it’s glory, gurgling away back in the middle of the shop.  I didn’t even bother asking Chad – how could I NOT go in this store?!

It was the most bizarre place I have ever seen, plopped down in the middle of an Adelaide suburb, close to a catholic cottage, an unimpressive “ice rink”, and some run-down buildings who hid their business names in shame (there was no identifying signs that I could see in most of them).  Inside was a random assortment of timber, light posts, life-size statues of Elvis impersonators (not even the real deal!?) Marilyn Monroe, a scuba diver, John Wayne, a leather furniture set with a couple of recliners, little gates, chests and gun-boxes that look like old books that you always see in espionage movies.  A giant plaster shark, a mermaid, a giant panda, and an entire wall covered in metal signs of every genre.

I wandered around, having a “butchers” (a British term c/o of our British landlord meaning “to have a look around”) for almost a half hour, before I left with two thoughts sloshing around in my head:  1) that would be an awesome store if I lived here and had money and 2) wth kind of store did I just go in??

Our First Day

For our first day we received a complimentary curb-side pick up from Chris. Once we arrived at the hospital, we were introduced to the man who would be our CI, or “Clinical Instructor” for the year.  He took us on a more in-depth tour of the hospital, and had a good chat with us about our program and exactly what we’ll be working on through the year.  This whole ordeal is new for all of us – the hospital has never taken on students from the US, let alone students with our program structure.  We must have had to explain how we – 4^th year students- have not had any clinical experience about 10 times, at least.  And for us, EVERYTHING is new:  the spelling of words, slang, protocols, measurements, the transit system…

We quickly realized that we couldn’t have gotten a better hospital to spend our year at.  Flinders is a teaching hospital, so everyone that works there is very understanding and used to working with students.   All the patients that come through there are very understanding and familiar with students as part of the exams.  We feel almost like we’re getting a bit spoiled, because quite a few of the crew have already been so accommodating and generous (like our curb-side pick up for our first day!!) Not to mention that our CI – one of the men we will be learning from for the next year – is the brain behind “Wikiradiology” – a website even our professors in Podunk little Klamath know about and use!

After stumbling through our tour and a sort of introduction to the hospital and department, we had the chance to get our hands wet – to get our hands on some patients and take our first x-rays!! And learn where some of those not-so-subtle differences (like measurements) really come into play!

Boy, did we jump heads first!  We observed and assisted with Weight-bearing Ankles, Ballcatchers views, Open-Mouth AP’s, Sunrise Knees, Coyle-Method Elbows, Flexion/Extension Spines, and SI joints!  To most of you these probably mean nothing, but to us it is a whirlwind of information that has started to gather cobwebs in our memories!  We laugh thinking back on our extern coordinator talking constantly about how many CXR’s (Chest X-rays) we’ll be doing, and how we will probably comp on them first, and on our first day I only saw a single one!  It’s wonderful!

By the end of the day, we could both proudly say we’d taken our first “official” x-rays; a wrist series for me,  and a knee series for Chad!

Settle Down!

I think we can officially say that we are “settled in”.  We’ve been calling Adelaide “home” for 3 weeks now.  We have an AUS address, and an AUS phone number.  We have an AUS bank account, and start our “AUS job” tomorrow (I think of it more as our “pro-bono” or “not-for-profit” volunteer work to make myself feel better about the lack of a paycheck, but whatever).  We know the busses necessary to get to the main places we need to, and aside from getting on the wrong one every once in a while, we are figuring it out.  Now I am just keeping my eyes out for a cheap bike, and dreaming up the vacation possibilities when we get time off work.

We took our preliminary tour of the hospital Thursday, and got a feel for the department. It seems so different from what we are used to in the states, making it both very exciting and scary at the same time.  Tomorrow (Tuesday the 5^th) will be our first day, so we will see how it goes!!

Home Sweet Home

It’s peaceful here for the most part. Little tufts of pale yellow hair cling to the corners and the bottom of the couch. A mandarin tree tempts me in the corner of the neighbor’s yard. And something in the palm outside the living area window makes funny noises at night.  The wood floors freeze my little toes, and there are only 6 or so channels that come through on the TV, but I suppose that is an even trade-off for being a couple streets up from the beach. Anyways, this is home for the next year.  We have found it at last!

Chad and I chuckle at the irony that after arriving in Adelaide we were met at the airport by a British woman, and were then treated to dinner by a New Yorker and a Tassie, and now we live with a British man, and soon his Canadian girlfriend as well! Chad loves that they have an old golden retriever, and is already attached to him.

Just 3 streets or so to the West is the beach.  A couple blocks to the North is a delicious bakery, a couple grocery stores, the Laundromat we dry our clothes at, the video store we have already frequented, and a Chinese restaurant that I’m sure we’ll become regulars at. Jetty Road (which obviously leads to one of Adelaide’s Jetties) has lots of cafes for us to try, and if we put in the effort of a 20-minute walk, we get to the major shopping mall of the area.

It is a rather convenient location for most of the things we need.  The Hospital is a hike, but still within reach if we want the exercise – a flat 5k.

There are buses of course, which make everything closer – pretty little Glenelg and the CBD.  We’ve been trying to learn the routes and I think we’ve taken the wrong bus at least twice a week – but you really shouldn’t get us started on that.  Really.