Friday, October 26, 2007
Odds and Ends
The last two weeks we've both been under the weather. I caught the flu and felt really rotten for about 3 days, then started to feel better, then got sicker again. I posed the problem to my students: purulent nasal discharge, right sided facial pain, + face pain on bending over, and "double sickening" over 10 days. Classic history and signs for sinusitis. It was so bad I actually took a sick day last week. (Not to be confused with a "sickie", which is Australia is a common practice of abusing a sick day to escape from work. And also not to confused with American "sicko" which has entirely different connotations.)
I believe I took about 4 sick days in the 14 years I worked in Cedar Rapids, so this was really unusual for me. I had to beg off my Wednesday flight, which meant that Cyril flew up to Gibb in my place. As always happens when one takes call as a favor to a colleague, a man collapsed just down the road, and was lucky enough to be only 10 minutes from the clinic. He was having a heart attack and at one point had a pulse of 23. I met this gent the next day in the hospital and he realized that he beat the reaper. He had his MI on the ONLY day a doctor or nurse was in the Community, he was close to the clinic and had someone who could drag him in, the ECG machine and other equipment sort of worked (always a problem up the Gibb), and the RFDS had a plane only 2 hours away and was willing to divert and let Cyril fly back as the flight surgeon. The chances of the stars aligning in such a fashion are rare in the Outback- he is one lucky man. And I was so glad I didn't try to fly with a clogged up, fuzzy head. Another stroke of luck for him that I wasn't on duty!
About the same time Vicki also came down with the flu. So we have been snorting and coughing at each other now for a couple of weeks. To add to the fun, one of the two aircon units in the house has busted. The replacements for these very old units are sitting on the back porch, but waiting on the workmen to come from Broome to install them. And the Kimberly is heating up now. Our back porch thermometer has hit 40C (102 F) daily this last week, so the aircon business is hopping. We took the bed apart and moved it into a room with a remaining working unit, and are praying that the cranky machinery can hold out till the workers get to us.
This week is the last week of instruction for the RCS students. My RCS guys have been in review mode for the last 2 weeks as we prepare for their OSCEs. They will have OSCEs in Port Hedland on Monday, so we all drive the 766 km on Sunday, then drive back on Tuesday. The exams are 7 minutes each, among 8 stations, with a minute between stations. They will walk up to the door, read a precis such as "A young mother brings in her 5 year old who has a fever and a large swollen gland beneath the jaw (see picture). Explain to her what the problem might be, and outline your diagnostic and treatment plan." Then the student walks through the door and performs the skill.
My guys have justifiably high anxiety, because the problems could be anything they have seen in the entire year, from reading an ECG or x-ray, to delivering the bad news of a terminal diagnosis, to demonstrating how to deliver a stuck baby. However, this type of exam should better predict later performance as a physician. Once they complete the RCS OSCEs, they have two more weeks to study, and then will join the Metro Perth students for final written examinations as well as a last round of OSCEs in Perth.
The written exams are NOT multiple choice, but the more traditional British-style exam, with questions such as "Discuss the differential diagnosis of urinary incontinence. Detail the optimum diagnostic algorithm, and discuss treatment for the most common problems." Vicki and I will fly to Perth for an RCS Coordinators meeting and I will help with the OSCEs there as well.
So we have been spending the last two weeks trying to fill in the gaps for things the students haven't seen here in the Kimberley. This mostly includes advanced cancer cases, cancer screening, musculoskeletal medicine, complicated gynecology, endocrinology, and advanced obstetrics.
And despite the heat, it is Spring here in the tropics. My tomatoes continue to produce. We have had wonderful papayas from trees in the yard, and the mango's should be ripe in a week or two. The frangipani are blooming and their heavy sweet fragrance hangs in the air when I come home in the evening cooling. I am enjoying the rainbow lorikeets and black cockatoos each day, and savoring the time left while anticipating the coming contrast to silent, snow-covered Maine.
I believe I took about 4 sick days in the 14 years I worked in Cedar Rapids, so this was really unusual for me. I had to beg off my Wednesday flight, which meant that Cyril flew up to Gibb in my place. As always happens when one takes call as a favor to a colleague, a man collapsed just down the road, and was lucky enough to be only 10 minutes from the clinic. He was having a heart attack and at one point had a pulse of 23. I met this gent the next day in the hospital and he realized that he beat the reaper. He had his MI on the ONLY day a doctor or nurse was in the Community, he was close to the clinic and had someone who could drag him in, the ECG machine and other equipment sort of worked (always a problem up the Gibb), and the RFDS had a plane only 2 hours away and was willing to divert and let Cyril fly back as the flight surgeon. The chances of the stars aligning in such a fashion are rare in the Outback- he is one lucky man. And I was so glad I didn't try to fly with a clogged up, fuzzy head. Another stroke of luck for him that I wasn't on duty!
About the same time Vicki also came down with the flu. So we have been snorting and coughing at each other now for a couple of weeks. To add to the fun, one of the two aircon units in the house has busted. The replacements for these very old units are sitting on the back porch, but waiting on the workmen to come from Broome to install them. And the Kimberly is heating up now. Our back porch thermometer has hit 40C (102 F) daily this last week, so the aircon business is hopping. We took the bed apart and moved it into a room with a remaining working unit, and are praying that the cranky machinery can hold out till the workers get to us.
This week is the last week of instruction for the RCS students. My RCS guys have been in review mode for the last 2 weeks as we prepare for their OSCEs. They will have OSCEs in Port Hedland on Monday, so we all drive the 766 km on Sunday, then drive back on Tuesday. The exams are 7 minutes each, among 8 stations, with a minute between stations. They will walk up to the door, read a precis such as "A young mother brings in her 5 year old who has a fever and a large swollen gland beneath the jaw (see picture). Explain to her what the problem might be, and outline your diagnostic and treatment plan." Then the student walks through the door and performs the skill. My guys have justifiably high anxiety, because the problems could be anything they have seen in the entire year, from reading an ECG or x-ray, to delivering the bad news of a terminal diagnosis, to demonstrating how to deliver a stuck baby. However, this type of exam should better predict later performance as a physician. Once they complete the RCS OSCEs, they have two more weeks to study, and then will join the Metro Perth students for final written examinations as well as a last round of OSCEs in Perth.
The written exams are NOT multiple choice, but the more traditional British-style exam, with questions such as "Discuss the differential diagnosis of urinary incontinence. Detail the optimum diagnostic algorithm, and discuss treatment for the most common problems." Vicki and I will fly to Perth for an RCS Coordinators meeting and I will help with the OSCEs there as well.
So we have been spending the last two weeks trying to fill in the gaps for things the students haven't seen here in the Kimberley. This mostly includes advanced cancer cases, cancer screening, musculoskeletal medicine, complicated gynecology, endocrinology, and advanced obstetrics.
And despite the heat, it is Spring here in the tropics. My tomatoes continue to produce. We have had wonderful papayas from trees in the yard, and the mango's should be ripe in a week or two. The frangipani are blooming and their heavy sweet fragrance hangs in the air when I come home in the evening cooling. I am enjoying the rainbow lorikeets and black cockatoos each day, and savoring the time left while anticipating the coming contrast to silent, snow-covered Maine.
