The St. Anthony Surge

I know my postings have slowed so I'll try to pick up the pace again. I've made some trips to L'Anse aux Meadows, Corner Brook, and St. John's -- as before I'll retroactively insert these into my blog along with the rest of my Atlantic Canada Trip and give you guys the link. These should be showing up in the next few days. I also think I've ranted enough about my Dad so I'll try to bite my tongue if I'm ever tempted in the future.

If anybody ever tries to force 4 tins of mooncakes (4 per tin) onto you, you should politely refuse -- unless you can regift 3 of them. Dad went overboard in giving me so many mooncakes -- I had to mail one to a classmate serving in Afghanistan and it still took me over 6 weeks to share and go through the ones I had left. Yup, Chinese fruitcake indeed.

As far as work is concerned, one of my colleagues decided to take a super-extended vacation (8 weeks) now that we have a surplus of anesthetists. With the 3 of us around, the numbers are just right although it is still rare for all three of us to be running an OR list. Usually the guy on call sits around in the office and handles all the little things that come through. We had a visiting urologist come in and (like most fee-for-service doctors) he wants to pack his list with as many patients as possible. With him around we actually did have 3 OR lists running. In general things also became noticeably busier over the last month. The good news is we shouldn't be in a situation of having too many anesthetists around until next January.

The only other comment I want to make about work is in regard to dealing with the administration. Now, I've ranted already about being an "employee" although I'm starting to warm up to the idea (a little bit). However, after sitting in on a number of staff meetings, a meeting with the CEO, and a meeting with the NLMA (the Newfoundland doctor's union), I now realize how sheltered I was as a resident. I've never enjoyed dealing with bureaucracies or office politics but now I've been introduced to both. I'm fast developing a dislike for committees -- as the old saying goes "To err is human. To really screw up, form a committee".

Fortunately, work is still enjoyable. I'm trying to make little changes in the hospital and trying introduce new drugs which I was used to using. We all had our desks upgraded and had new phones installed. The tender for a new anesthesia machine has gone out -- I can't wait to get rid of the ancient ones we're currently using. Despite the decent rate of acquisitions I'm still having "I wish I had...." moments from time-to-time. (Right now I'm wishing I had a High Frequency Oscillator for an ARDS patient in ICU).

Socially, I think things are going to work out just fine. As befitting my personality I'm slowly getting to know the OR staff and the medical staff. People here tend to hold impromptu gatherings and parties (especially as the frigid winters start to set in). Unfortunately, after living in a small bachelor apartment for many years my hosting skills have become quite stunted. Also, given the small living room in my apartment I don't think that will improve anytime soon. Oh well, I should at least work on a few dishes so I can bring something for the potlucks.

As far as the town itself, I'll admit my social life is still confined to the hospital. I still haven't signed up for the gym yet (my gut is paying the price) and, unfortunately, it looks like curling may not work out because I'm just signing up by myself and I need to join a team. For now, I'll be out walking the local trails and when it gets too cold to do that I'll have more impetus to joining the gym. One of the Family docs is a snowmobile aficianado and is trying hard to win converts. Although I still wince when I think of snowmobiles (i.e. traumas), I must admit I find the concept appealing. They're surprisingly expensive though ($12,000). When I next return to Toronto I'll be looking for snowshoes and also cross country ski boots.

I'm a little sleep deprived so I need to finish this post now. My next few posts should be up by the weekend.

Acclimatization

I know I haven't posted in a week so I'll cobble together what has happened so far.

I'm taking my time settling in and also reverting to old (bad) habits. I'm definitely a creature of habit so even though I'm falling into the same old routines it has resulted in a fairly easy transition so far.

The packing/moving company was super-efficient with my things. So much so that for a day or two I thought I was missing some relatively valuable items -- my computer LCD display and 2 large audio speakers. It turns out that they had stuffed them into a bookshelf which was subsequently wrapped up in cardboard. As they say, the last place anybody thinks to look is right under their nose...

Unpacking is much more painful than packing. So much so that 10 days after arriving I still have open boxes lying around. Well, I better stop being lazy and try to finish the move-in this weekend. Otherwise, I'm fairly happy with my new digs. Some of the other docs wrinkled their noses or grimaced when I told them I was staying at the "Orphanage". My boss in particular is encouraging me to live it up since I'm on staff now. Little do they know that this 2-bedroom is for me quite luxurious and I'll probably not be using the other rooms very much at all.

As for my first week at work, well, this slower pace is definitely going to take some getting used to. I think I've learned to be impatient after 6 years of residency in Toronto. Whenever there's a delay it bothers me for a brief moment until I realize that there'll be plenty of time for coffee breaks, lunch, and much chit chat with my colleagues and the OR staff. Oh, and I will also be finished around 2pm. Working without time pressure is something I haven't experienced for a long time so this is something to savour.

The downside is that should I ever return to a more hectic, community hospital I will have lost some efficiency and time management skills. A bigger concern of mine is whether I can stay sharp at this slower pace. I have been assured that I will see all manner of things here in St. Anthony: trauma, burns, myotonic dystrophy, etc. As the old cliche goes: if you stay long enough in one place, the world will come to your door. Nonetheless, we were just told that a 4th anesthetist will be arriving later this week. We were puzzling over this decision since we are now clearly surgeon-limited and with only 2 ORs per day max (some days only one OR) there doesn't seem to be enough work for everybody. Apparently, the decision was made at the regional level and the idea is to have an extra anesthetist who can back up the remote communities should they lose their anesthetist (which is fairly common). While I worry that I'll be twiddling my thumbs far too much for my own good, I've also been assured that once summer is over this place can get awful busy awful fast.

I am also becoming acquainted with the other docs and I've even been invited out to a few dinners. Everybody has been nice and supportive so far and the camaraderie here is definitely higher than what you might find at a large academic hospital. It's us versus the harsh reality of working in a remote area in a small province. I was briefly reminded of that reality last week when I had a mildly hypoxic lady in emerg and I realized that our old CT scanner wasn't able to detect pulmonary embolisms. (We ultimately had to send her to St. John's). But, fortunately, St. Anthony is a tertiary referral center for Labrador and northern Newfoundland and things are slowly changing. The CT scanner will be upgraded later this year, we're expecting one of our ancient Excel anesthesia machines to be replaced (its gas analyzer is intermittently failing), and we'll be getting a GlideScope. Woo hoo!

The only thing I really haven't done yet is to really get to know the community. In fact, I haven't wandered far beyond the hospital or my apartment just yet. The hospital VP commented that the doctors coming through here generally fall into two groups: those who keep to themselves and only work in the hospital to those who are completely involved with the community. I know I tend toward the former but I'll try to move towards the latter. It's definitely going to be quite a shock shifting from the anonymity of living in Toronto to the if-you-sneeze-everyone-will-know feel of the small town.

A family doc told me this story and I'm not sure whether to laugh or to be afraid. He drove down to Corner Brook which was 5 hours away and bought a microwave at Wal-Mart. No sooner had he arrived back in town than people started asking him how his microwave was working! (Apparently, a St. Anthonian saw him loading his microwave into his car in the parking lot and the news just spread....)

Well, I'm not on call this weekend and I think I'll take advantage of it by doing one of many drives down to Corner Brook. Even though I could be thrifty and watch TV through my computer monitor I think I'll splurge a little bit and get a proper flat screen TV. On the other hand, since there's a good chance I'll be moving again in a year I'm not going to go crazy with a huge one either. I'll probably get a 32" model that I can easily transport back to Ontario. In addition to watching a movie I'll probaby be on the hunt for some restaurants. The Chinese restaurant in town leaves much to be desired although it will (barely) satisfy me after a week of eating hospital food. Corner Brook has two Chinese restaurants I think so I'll be checking them out (hopefully one of them has dim sum).

Sorry, still no photos! We're expecting a cruise ship next week and, if the weather is nice, I'll try to snap some pictures of it and the town. I'll also try to hike the trails up the hills surrounding the town as well. The weather so far is typical St. Anthony -- cloudy, somewhat wet, and cool with temperatures in the teens. I'm not a huge fan of hot sticky summers so I don't mind wearing long clothes but I would like to see more sunshine.