Another Pair Of Eyes

Rotorua

Rotorua -a small town on the New Zealand tourist trail. It stinks of sulphur (I refuse to Americanise it to ‘sulfur’), is packed with adventurous activities, and in theory is an awesome place to be.*

And actually, it was amazing. Three hour drive, which was just stunning. Hostel with a geothermal swimming pool and a dorm, which while about 300 degrees** were a lot of fun. And then caving and luging and a massive swing thing and all sorts of stuff that broken arms probably aren’t supposed to be involved in. ‘t was awesome.

Luging: not actual, face-inches-from-the-floor luging, but some kind of strange mini go-kart things which you ride down a track which winds down a hill, then chairlift back up to the top. Sounds pretty tame but they are low to the ground, skid happily around corners, and the more advanced trails are damn quick and come complete with chicanes, banked corners, and steep straight sections.

Caving: the caves at Waitomo are filled with freezing water and freezing air in equal measure. We were (wet)suited and booted, and floated through the caves on inflatable tubes, pausing occasionally to jump off waterfalls or squeeze through rocky clefts. You can’t quite convey the atmosphere down there – the darkness is absolute, and the thunder of unseen water is constant and somehow both threatening and intriguing. Underground the caverns are timeless, grand and mysterious even in the well-travelled, guided sections we explored.
On top of all that were the glow-worms. At points we turned off our lamps and plunged into absolute nothingness, only to glance upwards at the constellations of them above. Stunning.

Geothermal park: pretty tame by comparison, and most definitely not worth the $30 entry fee. Go to Iceland, as it’s infinitely more awesome. A steaming coloured pool doesn’t do it for me anymore unless it regularly explodes or something.

Summary: this sort of weekend is why I came travelling. I’d write more but it’s time to hit the wards again…

*operative word: ‘theory’. Broken arm much.
**botha the room and the pool, actually.

Airborne

So. This week I am on PICU, or paediatric intensive care unit. It’s hard to write this because I’m currently sitting in a helicopter on route to an emergency transfer patient and the vibration makes it hard to type. Basically, in comparison to DCC (department of critical care, with the waiting and the staring and the hours of nothing happening), PICU is undeniably awesome. Yesterday: angiography (visualising blood vessels in the brain using a massive x-ray machine and radio-opaque contrast to map out the locations of abnormalities) and watching a baby’s chest being closed after a successful repair of tetralogy of Fallot. Today started with the usual dull-as-dishwater ward round but an hour later I’m wearing a flightsuit and en route to the airport. Originally we were going to be flying a planebulance (not a real word) but it got requisitioned by a priority one cardiac ICU transfer ECMO patient (Extra-Corporeal Membranous Oxygenation, which requires a plane to transport) so instead we got upgraded to a helicopter. And that is why I am typing this at 6000 feet, vibration, etc. We’re going to land on the hospital helipad. It is pretty damn exciting.

Right, we’re coming in to the town location now, so I’ll write more later.

Later: now flying back, with a child and father on board. The kid isn’t too ill at present – it’s more a worry about deterioration later today that prompted calling in the chopper. We’re landing directly on top of the hospital, with medical priority through Auckland airspace, as facilities aboard the helicopter are understandably limited and there isn’t a lot of free movement if anything should go wrong. Weather is rough as well; can’t see anything and there is significant turbulence so landing might be interesting. On the plus side, PICU is about 100m from the helipad so won’t be much delay between landing and being on the unit. ETA 15 minutes.

Later again: day done. Admitted the little boy to HDU (high dependency unit – a step down from true ICU in the quantity of nursing and intensity of treatment, but beds are inside the overall PICU so transfer is as easy as moving staff if necessary) for the night, having spent 6 hours completing the transfer door-to-door. It’s been a pretty awesome day, no less, and totally not what I expected to be doing! Learned a little along the way, but mainly it was just damn awesome.

And that’s that. Pictures to follow.

Heartbeat

Today, I watched a baby’s heart beating.

Literally. Directly. With my own eyes.

Holyshit.

Digging

When you tidy your room you never know what you might find. Found before I left, old thoughts.

Code

‘Code red, ward 54, room 15′ reads the pager, and we move, abandoning the chest drain we have spent 15 minutes meticulously preparing.
It’s the role of doctors on the ICU to respond to any code red* (something potentially life threatening requiring urgent review) or code blue (start CPR) in the hospital, as they have the most experience dealing with arrest situations. A code red callout covers a large range of issues from the worried nurse of a distressed patient to serious and deadly emergencies in which every minute counts. This was my first code, it was code red, and as we hurried down 4 sets of stairs I didn’t really know what to expect.

We were back in the ICU within ten minutes. The code red should have been a blue, and the blue shouldn’t have been issued. When we got there the patient was already dead, not for resuscitation, and so we turned around and walked back to the unit. His name was John. I never did find out why he died.

Sometimes we win, sometimes we lose, and sometimes we’re not sure.

*along with a host of other people.

Castaway

So, today – a mere 9 days or so after being put in plaster – my cast has come off. Early mobilisation, they say. No signs of rotational block, they say. Minimal chance of further displacement with (low load), they say.

I say, goddammit yes, I can do stuff again! Cannulation is low-load, venesection and ABGs* the same. Clinical win! Things like showers and getting a coat on and cutting up food need no longer be an awkward mess of angles, and although I can’t drive now I’ll be able to in the next few weeks.

It’s not an immediate return to form, obviously. Elbows stiffen very quickly without use, and I cannot straighten my arm because the muscle is so tight over the joint. Flexing it is easier, but again the full range of movement has been lost. It (should be) temporary but it’s a bizarre feeling of limitation. In addition I am firmly told to spend the majority of my time using one of those slings made of black foamy stuff with straps on to minimise loading movements and to stop me falling into things and leaning on it etc. I’m not supposed to do anything vastly more strenuous than carrying a glass.

But hey. All the above will improve. For now…FREEDOM!!!

*arterial blood gases

Arrival

I arrived in New Zealand on tuesday after a very long time spent in very small (and not hugely comfortable) spaces and have had a few days to get an impression. New Zealand is like Britain Mk.II. The winter is milder, the bottles of coke are 600mls, steak is cheap, rugby is the national sport and scrubs have pockets on both sides. BOTH. SIDES. Have you any idea how much of an improvement that is?!*

Ahem.

Today is day 3 of one-armed ‘working’ in Auckland City Hospital intensive care unit. It’s a mixed bag – there are things going on here which are far and away beyond the average ward business and can be really quite amazing (closing up a chest on the unit, anyone?). Sadly the rest of the time nothing is happening, the patients are all unconscious and there is nothing to do.

Example: day one. Turn up, ward round, then see two tracheostomies and a cardioversion (like a planned defibrillation, with the electronic pads and people yelling ‘CLEAR!’). Never seen any of that and it was non-stop action. Then, in the afternoon, I sat in the office staring at walls and admiring the paintwork.

It’s difficult to do the things you’d normally do on wards when it’s quiet as well – as mentioned previously the patients are either unconscious (and can’t talk) or have a tracheostomy (and can’t talk) so you can’t chat to them. Bastard-bloody-broken arm means I can’t take blood or put in lines or even examine people, so all that’s left is to wander aimlessly around or sit and read. Even trying to find out about patients is hard because the intensivists speak medical jargon to a whole new level of speed and abbreviation, and do not seem to require patient notes, cues, or traditional English vocabulary to do so. It’s…frustrating. There is so much to learn/do here but it is just out of reach. I don’t want to come across negatively, it is good, but not ideal. Then again, what is?

Other stuff – we’re going to hire a car to get around as public transport is poor at best, but until that happens at the weekend it’s nothing going. The houses here are huge and spacious, the views are gorgeous, and frankly if it weren’t for the 24 hours flying I’d need to do to visit family, I’d probably emigrate here. I say probably – not everything about New Zealand is good. For example today there were only extra-large scrubs available, so I’m feeling disillusioned. Oh, and the Kiwis really suck at driving. Even so, I’m only half joking about emigrating in future.

I’d say more but other than be in the hospital (which is just amazing and spacious and new) we’ve not really had the chance to see or do anything so there isn’t a lot more to add at this juncture. Hope the British is treating you well, and watch this space.

*there are still, however, no medium tops. It’s not perfect.