First week at work!

I was happy to start work, but the title of this blog sounds more interesting than it actually was. I have yet to see a patient. Four days of orientation that were necessary to understand the workings of the huge hospital (10 floors!!).

The first day was a general orientation for all newbies to the Royal Children's Hospital. It was useful to get a tour of the building, and learn a bit about the system here. The two hours of sessions on how to recognize a sick child and how to order IV fluids became a bit tedious, but I really appreciated the chance to meet some other international visitors to the hospital.

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It seems that most people come from either Germany or the UK, and they come with reams of experience. I've been feeling that I'm getting old without ever having had a full time staff position. Nope. Here, I am green as green can be. The registrars (what they call residents) from other countries come over after years of training in their field. One woman also doing PICU has had a couple of years of NICU training, and is now on her fourth year of PICU training. I met a guy from Australia who is starting his training in ENT surgery. He has already done 6 years after medical school - 4 years of surgery, one year of general internship, and a year of finding himself. I think that the major difference, though, is that the training in Europe and Australia/New Zealand involves fewer hours per week, and the pay is better. This seems to give less of a sense of, "if I can just get through these next few years...", and more of a sense of, "why would I want to ever stop training?" I am hoping that I'll be able to learn a bunch from everyone's collective years of training.

The next three days were an introduction to the PICU. It seems like a fantastic unit. It isn't particularly new (the RCH must be about 50 to 60 years old)but the standards of care are high, the staff are excellent, the fellows (again, called Registrars here) are smart as whips, and the nursing staff seem keen and very experienced. There is a degree of respect given to the nurses here that I have not always encountered. Our handbook specifically tells us that we are to call the staff intensivist any time a nurse thinks that we should. We have been told on numerous occasions that, if we don't know how to do something, the nurses probably do. I am impressed to see this acknowledged so clearly by the staff, and get a sense that there is a real professionalism and cooperation amongst the team.

I will miss the respiratory therapists. In Canada and the States, if a child has an issue with breathing, the physician works with a member of the health team called a Respiratory Therapist. They know everything about the mechanics and physiology of breathing and problems with breathing, they run the ventilators, they help with mobilizing secretions through physiotherapy, they assess and administer medication for asthmatics...they are generally REALLY important. Here, the registrars and nurses do the jobs together. I am going to miss the RTs. Fortunately, they have these wonderful people called, simply, technologists. They know how all of the medical machines in the hospital work, which means not just that they understand the nuts and bolts, but they have been trained in the physiology behind human machine interactions. This is particularly relevant for ventilators. I, for one, am really glad that they are around.

The paper work required at the hospital is feeling a bit overwhelming. I thought that we would have more paperwork in Canada, being north of the biggest litigators in the world. Not so. For each child there is a written note, a typed note, an update entry into the discharge summary and an update on the handover sheet to complete...every day. Actually, twice a day because the day and night shift have to do it. Perhaps it will feel like a bit less when I'm actually doing it.

For now, I'm on off days while I wait for my 7 day stretch of 13-hour shifts to start. Now is Sunday, and this weekend Melbourne had the hottest day ever on record for the state of Victoria. The mercury reached 46.5 degrees celcius. This didn't affect Paul and I particularly, as we closed all of the windows and blinds, turned on all of the fans, and spent the day chilling out. It was over for us by midnight. But, unfortunately, not everyone has fared so well. The news continues to report fires still burning, and shows pictures of devastation from fires across the State of Victoria. About 80 people have ended up in hospitals across the city with burns. I suspect that there will be a few in the pediatric ICU when I arrive on Tuesday morning. Many more have lost their homes and livelihoods. It is not surprising, given the dry weather over the last 8 weeks. The first rains came last night, and there were only a few millimeters in total. The trees have been dropping leaves like maples in a Canadian fall, but without the vibrant colors. The grass is brown and plants are, for the most part, wilted. I've never wished so fervently for rain.