First day huh?

Howdi

Can't believe we've been here a week already. We've had a pretty busy week, setting up phone, TV, internet, mobile, getting a car, insurance, etc. I've already created a pretty impressive paper trail. We've had some fun too. Ann Arbor is really nice. The town centre is small but has really nice restaurants, cafe's and bars. There are some nice boutique shops, book shops, etc. There's a big shopping Mall for all the usual stuff out of town. There's lots of parks too. People here are friendly and will start up a conversation on the street or in a cafe.

Next blog I'll post some pictures of the house and the area.

We've had a few trips to the supermarkets too which are huge. Like 3 supersize Tescos under one roof. Or maybe it just feels like that.

We've also spent a small fortune. Moving country is expensive. The USA is also expensive. However, we are well paid here, so I'll be OK when I get paid. The first month will be a bit tight though. I've spent the $10,000 loan we got already. Car, rent and car insurance. Ouch.

I had my induction at work yesterday. A nice welcome from the chief, an explanation of the job and our roles, a (long) explanation of the computer system and the billing system (which feels very foreign - there are no paper notes here - all the records are on computer - and it is actually amazingly easy to use, it really works.)

We had pagers, personalised white coats, ID badges and everything all ready for us on starting. No tedious fire lectures, no manual handling lectures and no long boring whinges from the pharmacist / security / etc. In other words this was actually an induction that was useful and to the point. Although the lectures on billing was a bit over laboured - but then it is really important here. Basically if we don't say we did something, the hospital can't bill for it, and the hospital loses money. The anaesthetic dept alone needs $2 million just to pay the bills.

Today I had my first work day - although I just shadowed one of the attendings, so it was a nice easy intro. The day for me started at 05:15 with an early wake up call. A quick cycle in to work in time for the 06:30 M&M meeting. This lasted an hour and was well attended by most faculty and residents. A few critical incidents were discussed briefly, then a difficult case was presented and the residents were grilled on it. I found it really interesting and educational. The case was complex but not small print stuff. It was in a big lecture theatre but there was a very non-threatening environment. People were very open to different opinions. Best of all there was Starbucks coffee and bagels, muffins and fruit.

After the meeting I met up with the attending I was shadowing and met our first two patients (1 for each room we were in charge of). Both rooms were staffed by CRNA's - nurse anaesthetists. This was my first real encounter of a CRNA - and I have to say that if I wasn't told they were CRNA's I wouldn't really know. They are well trained, knowledgeable and experienced. And they do really complex cases. I guess they're a bit like staff grades at home. When I go solo I've been told we'll be supervising residents mostly rather than CRNAs.

In 1 room we did 3 laparoscopic prostatectomies, and in the other room a laparotomy and a thyroidectomy. Not a bad day for the logbook. We (the attending and me) were there for the induction and positioning and emergence. The rest of the time I chatted to the CRNAs, checked my e-mail and submitted yet more paperwork.

The biggest differences I noticed at work so far were:

No anaesthetic rooms (which I definitely agree with)

Fully computerised notes (Absolutely the way forward)

NO ODPs (which is disconcerting)

Covering 2 rooms at once (which is really not that bad - but maybe I was just lucky today)

Seeing the patient for the first time in the holding bay. (The holding bay is more like a pre-op HDU though. It is well staffed and has full monitoring. There's 20 or so beds so the patients can come down really early to minimise delays. We do review the notes online before though and discuss any problems)


Anaesthetics are not much different. Cost is if anything more of an issue here than the NHS. Isoflurane is definitely first choice volatile. Sugammadex is a no-no. There is a lot more investment in equipment and infrastructure however. Like I said before the medical centre is huge, and state of the art.


Well done if you made it this far and haven't been bored to death. I'll try to put pictures and more interesting anecdotes in future blogs.

Oh yeah - The weather here has been fantastic . Sunny and warm.

Keep reading,

Drake.