Life in the Emergency Department -- Aussie Style

OK -- so it wasn't really retirement (except for Ellie who managed to get off all her boards, committees, and volunteer positions).  But for the Tuckster it has been back to the salt mines.  And, as promised, here is a view through the keyhole:

I should mention before continuing that my expectations concerning the bodies of Australians, before our arrival, were those of sun tanned and sculpted bodies on people who were athletic and in great shape.  And therein lies the problems with expectations ... they are hard to live up to and when juxtaposed against reality, it can get pretty ugly.

Now, I'm not saying that the people I'm seeing are fat, out of shape, or unhealthy but I will say that they have nothing on the populace of West Allis.  Considering that this is a country that has produced so many Olympic champions, movie stars, and beautiful people, it was quite a shocker to see what comes in the door.  Australians in Bundaberg tend not to care for themselves any more than the average State Fair attendee in Wisconsin.

My first observation is that there seems to be a LOT of skin infections -- cellulitis and abscesses.  Now I'm not saying there is an extraordinary amount of close contact going on or if people are just more susceptible to these organisms, but whatever it is, the microbes seem to be winning.  And these aren't immunocompromised people -- just people (admittedly, often with poor circulation that can probably be attributed to their significant number of smokers).  Otitis Externa is also a big hit amongst chief complaints but this I can understand in that, given the heat, people spend a lot of time in the water (rivers, lakes, and ocean).  And of course there is the expected large amount of chest pain, abdominal pain, complications of diabetes and high blood pressure, and drunken trauma...but what has intrigued me are the exotic attacks from nature.

The night before I began working a handler at a local animal park was attacked and pulled into the water by a large crocodile.  Fortunately, another handler was able to "distract" the croc (how the heck do you distract a croc that is in the process of gobbling up a human?) long enough for him to escape with only loss of his thumb (first metacarpal and all -- "like a drumstick" was the description by the resident who took care of him).  And what did the handler have to say about the attack -- he was worried that the croc would be blamed because he (the handler) was the one who wasn't paying attention.

Then there are the venomous snakes... Brown Snakes seem to be the most common around here and fortunately their bites are often without envenomation (dry bites).  When they do envenomate the patient, it causes a severe coagulopathy (unmeasurable INR -- the blood just won't clot) that somehow (?) usually does not cause bleeding.  But a small fraction of those bitten have sudden and complete cardiovascular collapse (their blood pressure just falls to zero and they will die without immediate resuscitation) -- poor buggers!

We are very fortunate by the land formation around Bundaberg that we are protected from most jellyfish but occasionally a few slip through.  We had an Irukandji jellyfish poisoning the other day which causes marked hypertension, painful neurasthenic burning of the legs, rise in troponin, and may lead to death from heart failure.  And, of course, there's the guy from Wisconsin staring open-mouthed going, "Golly, you don't see that very often in Wisconsin!"  Needless to say, I have over-whelmed them with my medical (and toxicologic) sophistication.

If any of my partners would walk into the department, they would be shocked.  No one gets undressed.  Seriously, everybody has their street clothing on and I see no way of changing that custom.  They also are very reluctant to certain exams -- if you want to do a rectal exam (well, who "wants" to do a rectal exam, really?) but let's say you need to do a rectal exam because it's indicated, you had better be prepared to carefully explain "why".  Then, go look for the hemoccult paper (not "card" but paper -- approximately 1 inch in length and the width of 2 pieces of pH paper -- very easy to handle).

Need to perform a pelvic exam -- even better.  There is no pelvic room (or rooms at all for that matter).  Bundaberg took their privacy cues from St. Luke's where curtains prevent anyone from hearing what's going on next door (but I've been assured they are sound-proof curtains).  So, if you can convince a nurse why you need to do a pelvic exam, you flip over a bedpan (to elevate the pelvis enough to be able to insert a speculum) and hope that the bedpan doesn't collapse before you finish the exam (I'm sure that I mentioned that the bedpans are made of cardboard, right, and they always collapse during these exams?).

Anyway, Ellie has now told me that I am over my space limit so that's it for tonight.  I hope I haven't been too graphic or offensive.  These are my "peeps" now and they really are wonderful people who almost without exception say "Thank-you, doctor" ... and mean it.  They are honest, warm and welcoming.  Without hesitation I can tell you right now, it's already been the experience of a lifetime!