The road less travelled.

We are now past half way through our year here. Fall is here, and Ann Arbor, famous for having lots of trees, has had a beautiful explosion of Fall colours. Our street has turned bright red, orange and yellow. The Halloween decorations are coming out too. Some of our neighbours are going for the whole haunted house, complete with animatronics, strobe lights, fog machines, fake graveyards and skeletons in the garden. The shops are full of Halloween decorations and costumes, pumpkins, pumpkin pie. The pubs have Halloween pumpkin beer, Starbucks has Pumpkin spiced latte...
Football season started last month, and despite all the warnings I was still amazed by how big it is. The Big House is the University of Michigan football stadium, about 5 blocks from where we live. It holds 110, 000 spectators, and it sells out for every single game. On match day the whole of Ann Arbor is taken over by football mania. Everything is blue and yellow, and emblazoned with the Michigan "M". Even the sky gets decorated with a huge M. People from all over Michigan, and meet up with mates to have trailer parties - they fill their trunks with cool boxes of food, beer, barbeques, and make a whole day of it.



The weather has cooled, it's not humid, but we've had some beautiful hot sunny days. I think it's been my favourite time of year so far.

We have been exploring quite a bit too. One of the best things about taking a year to work abroad is the opportunity to travel and really get to see a country, go to places that you wouldn't normally visit, get out to the roads less travelled. America is the perfect place to do that. It is a huge country, it has every kind of landscape, climate, activity that you could ever want on a holiday - whether you are in to city breaks, or getting away from it all, beach holidays, mountains, skiing, ranch. It is also incredibly easy to get around, and from Ann Arbor we are lucky enough to be only 30minutes drive from a major airport (Detroit), and on 2 major interstates, 1 going North-South, and one going East-West. We are an hour drive from Canada, within 5 hours drive is Niagara, Toronto, Chicago, Cincinnati, Northern Michigan, Pittsburgh. Within 1 hours flight is Washington DC, New York, Boston. We have tried to make the most of our free time.

Last month we had a lovely city break in Washington DC. An amazing city to visit, with so many interesting museums, buildings and great restaurants. The Smithsonian museums are definitely not to be missed.

Last week we came back from a mammoth 2 week long road trip, taking in 7 states. We visited the beautiful beaches of the Outer Banks, North Carolina, and the awesome Great Smoky Mountains national Park of Tennessee - just 10 hours drive from Ann Arbor. The USA is built for driving. It's so easy just to get in a car, and drive somewhere with no plan except to explore. Motels are commonplace and reasonably priced, and there is no shortage of places to eat. Petrol is pretty cheap too, thankfully, as I'm driving a big gas guzzling tank. I think there's something ingrained in the American spirit about the freedom of the open road and exploring the road less travelled. Now with Sat Nav and an iPad, it is also much easier to find!


Separated by a common language...

I still find myself having to repeat things over and over at work, in restaurants, or especially on the phone. I don't think I've picked up an American twang, although sometimes at work I hear myself saying things in a very American way. Reassuringly there are some Brits who have been here for 20 odd years who sound very English still. Not that there is anything wrong with talking with an American accent of course! (Unless you're travelling anywhere else in the world).

I have been known though to say some American phrases - especially at work. You have to really, to fit in and be understood. To Quote George Bernard Shaw... Two countries separated by a common language...

Some examples that are useful phrases to know for anyone planning to come and work here:

Labs = Bloods
Vitals = Obs
EKG = ECG
Flashlight = torch (if you say torch they think of a flame - I spent ages once trying to ask for a pen torch with the poor nurse thinking I was mental)

H&P (History & Physical) = Clerking (History & examination)

OR (Operating room) = Theatre (I keep saying theatre by accident though which results in either strange looks or smirks)

PACU = Recovery

MAPS (Monitored Anesthesiology Provided Sedation) = Sedation (conscious or unconscious - something more like a General anaesthetic without an airway...)

MAC (Monitored Anesthetic Care) = A case under local with or without sedation with an anesthesia provider present.

QA event = Critical incident

Scooch your heini... = Shuffle over

Stretcher / Gurney = Trolley

You all set ?.... = Are you ready?

You're all set. = Yes you are ready

It's all gooood. = It's fine / No problem / No big deal

It's Dandy. = It's nice.

Good job! = Well done!

One of my biggest bugbears here though is the use of trade names for drugs instead of generic names. It's really confusing and embarrassing when I have to keep looking up drugs or asking what they are.

What surprises me still though is how much is the same. It's reassuring that we get taught the same stuff on both sides of the Atlantic. Physiology, pharmacology and physics do not magically change when you cross the pond (although the SI units didn't quite make it over), and the anatomy is the same (but sometimes just expanded!!).


Work has had its crazy moments. One day last month I was looking after a case in one room who was having jet ventilation for a subglottic stenosis with a CRNA who had never done it before, and next door looking after a novice resident doing his first craniotomy. It's all good.....


Till next time,

Drake