The week that was

Paul and I had our first week of work. Work it was. My shifts are truly shifts now. The day time shift is from 8am until 9pm, and the night shift is from 8pm until 9am. You can get out slightly earlier than 9 if handover goes quickly, though it rarely seems to. Last week I started with three days of day-shift, then two days of night shift, and then two nights of Pediatric Emergency Transport Service (PETS) call. It has been interesting, and exhausting.

Day one of work - all I really remember is running around like a chicken with its head cut off, and not know how anything worked, where anything was, or how to do any of the administrative load. Fortunately, none of my patients acted up. My first task was to administer a general anesthetic to the baby coming off of cardiopulmonary bypass (called ECMO when they are on it for extended periods of time). I'm used to the anesthetists doing this, so it was a new experience for me - I couldn't see the baby the whole time, and don't think that I took my eyes off of the patient monitor for two seconds.



Next was figuring out how to do all the paperwork. It was a really good thing that I was only in charge of 3 patients that day...sooooooooo much paperwork. We are incredibly spoiled in Canada. If you want an IV fluid and a drug, you just order them on an order sheet, and the nurses transcribe them to a patient kardex (for example, midazolam 4mcg/kg/min). Here, there are order sheets for every different type of medication or infusion: an order sheet for IV infusions, one for regular drugs, one for frequently given medications, and a different one for one-time infusions. The IV infusions have to be rewritten daily, and you can not just order the drug to be infused. One must order how the drug is to be mixed (for example, 3mg/kg of midazolam = 35mg in 50ml of 5% dextrose-heparin, 1-4mL/hour = 1-4mcg/kg/min). It is all very time consuming!

By day three, I was getting the hang of it. I had to intubate one of my little patients who was not doing very well, and gained a new appreciation for all that the respiratory therapists at in Canada do. They get everything ready, do the taping, make sure that we know what equipment we are using, set up the ventilators. Here, the nurses are amazing, and with their help I'm learning to set everything up for myself. So much to learn! I do love being able to change the settings on the ventilator without getting my hand slapped by the RTs though.

My two nights were relatively quiet. You aren't supposed to sleep over night, because it isn't a 24-hour call but a 13 hour shift. So, when things aren't exciting, they are painfully slow. I circled the rooms many times checking on blood work and ventilator settings, but the nights do drag on.

The last two nights were PETS calls. The first night, blessedly, there were no calls so I got to catch up on a bit of sleep. Last night was a doozie, though. The PETS team is the regional transport service for any child felt to be sick enough to go into a pediatric hospital. They don't need to be sick enough for ICU, just the hospital. Which means that we seem to transport a few not-so-sick kids who, at least in Ottawa, would be transported by regular ambulance service. My phone call at one am was for a cute, but very cranky, 18 month old having an asthma exacerbation. He was stable, so we babysat him while we went from a hospital in Frankston to the other peds hospital in town (Monash). When we got back by cab to the Roayl Children's, there was another call waiting for us. So, out we went again to a hospital called Box Hill, where there was a significantly sicker child. I finally got back home around 10:30 this morning, and crashed.

During this crazy week, which I am to repeat many times over this year, Paul was sweet. I had dinner at night, the bed was made (which was good because he clearly was not going to wake up at the same time as me), the dishes were done...how lucky am I. He has started working on his year-long project to try to make a go of stock trading. Slow going at this point, as he is still at a stage where he is setting goals, reading and finding a relevant computer program. It isn't looking like actual trading will take place for the first several months, but he would be better able to describe that, and I can't seem to get him to contribute to the blog.

I think the major highlight this week, though, was getting a bike. It's a great little hybrid that I got used at a very nice bike shop. The brand is Kumo, which I had never heard of before, but is apparently a Canadian brand, and the exact bike is a Dew. It's got new wheels, new pedals, and a bell! Not that anyone here seems to pay any attention to the bells. There are cyclists everywhere, and they are generally ignored by both the cars and the pedestrians. So, I also have a goof helmet, and a flashing back light, and now I just need a front light. The freedom! I feel like I can get anywhere, and it is so much faster. Also, after 13 hours of work, the last thing I feel like doing is walking home for 35 minutes. Although it isn't far, after my shifts I seriously lack motivation. Tomorrow I'm bicycling down to the beach at St. Kilda's.


Now, I'm on a week off. The benefit of working like crazy. I'm not sure if the week on/week off thing will last, but for now, I'm looking forward to some serious sleep!