The holidays are coming!...

I'm sure back at home all the Christmas lights are up already, and the supermarkets are packed full of mince pies, puddings, Christmas chocolates, Christmas trees, decorations, etc. Here though Christmas still seems a long way off, because the focus is on Thanksgiving which is on Thursday.

We're all really excited about it here. An extra cause for celebration and we get 4 days off (well - I'm working the Wednesday night - but it's not bad really), and we get to try American thanksgiving dinner! Traditional thanksgiving dinner is Roast Turkey and trimmings, which are apparently more like a mashed vegetable pie, rather than our parsnips and sprouts affair. Dessert is pumpkin pie or something similar. The following day is traditionally the opening of the Christmas shopping season, and a lot of stores open up at 5am for special holiday season sales. It is called Black Friday - presumably so named by someone with a phobia of shopping like me.

As well as eating, drinking and shopping, it's all about visiting family, so a lot of people travel. No-one seems to know what they are actually giving thanks for. I've asked quite a few people about the history of it and no-one seems to have ever even thought about it. I always thought it was something to do with the early colonists giving thanks to the Indian tribes for giving them food but apparently this is not true. Even wikipaedia my trusty source doesn't seem too sure, but for those who are interested in the various theories follow this link...

http://en.wikipedia.org/wiki/Thanksgiving_(United_States)

Anyway - its a holiday, and we shall eat, drink and be merry... and very thankful.

The football season is coming to an end. Just as I am writing this Michigan have just lost their last home game to Wisconsin. I went to one game two weeks ago. The department chair has some amazing season tickets at the 120,000 seater "Big House" stadium, and was unable to go himself, so kindly donated his tickets to the rotators. They were probably the best seats in the house.

The game was Michigan vs Illinois. We took our seats half an hour before kick off, all wrapped up in about 6 layers (it was chilly) though I actually ended up quite hot. We were so close to the visiting players bench - and they had gas powered hot air blowers to keep them warm. There's not much emphasis on eco-friendly - even in lefty liberal Ann Arbor. The marching band kept us entertained before kick off, and then all the way through the 4 hour plus game the band play and cheerleaders entertain. The game itself stops every 10 seconds or so, as anyone familiar with American football knows. It really is a weird sport. For a start they have a completely different team for offense and defense, they play for 10 seconds then stop for a minute or so before restarting. A game of four 15 minute quarters can last for 4 hours or more.

The game I went to went into overtime as well. Final score was 67-65 to Michigan. It was very exciting though, and there's a great atmosphere in the stadium. The band play every time there's a pause in the game just in case the football doesn't keep you entertained. It's quite a spectacle. Not as good as rugby in my humble opinion, but it's a huge deal here. The city is taken over on match day - even the skies above it are filled with planes towing banners.

Where we live close to the stadium - we can even hear the cheers when they score. This season though the cheers have not been that frequent... I think I may have jinxed them.

All the rotators have Christmas off. There is a tradition that the Brits work most of the American holidays here, but we usually get Christmas off. We've decided to stay here in Ann Arbor. Some of us with young kids are planning to get together on Christmas day and have a big feast. Hopefully we'll have lots of snow, log fires, snowmen, an obscenely large Turkey, chestnuts roasting on an open fire.... We've had to get Christmas pudding from home of course.

The elections are coming!... (in 2 years)

The news here seems to be full of predictions of Obama's downfall. The midterm elections were a bit of a disaster for him and the Democrat party. They now have a completely ineffective government for the next 2 years at least, as the 2 houses - the house of representatives and the house of senate battle it out, with neither likely to be able to get a bill through. Obama's health care bill is likely to be toned down if not scrapped. All of which makes very depressing reading for an Obama fan like me.

I really don't get it. If you asked what defines America, most would say freedom and democracy. Obama was democratically elected to be president by the will of the people. They voted him in on a manifesto of Change and in particular health care reform. God knows they need it. You ask anyone here whether they think the current system should stay as it is and most would say no. They spend far more per head on health care than any other country in the world, and yet nearly 1/3 of the population have no insurance and no access to it. The money is all being spent on a very small proportion of the population. Many despise the notion of universal health care because they link it to socialism and because they feel it's too expensive, but they don't realise that they are already paying for it in other ways.

Those on medicare and medicaid are getting hugely expensive health care paid for by taxes. If someone has no insurance and does not qualify for medicare or medicaid they are not just left to die on the streets, they still get treatment - at hospitals like the U of M, and that has to be paid for still somehow - either by taxes or by hyperinflated insurance premiums for everyone else.

Health care here is the most common cause of bankruptcy. It is sending the country into huge debt, but it also make a lot of money for those companies involved in delivering it, and they appear to be more effective at campaigning than Obama at present. Many who support health care reform have turned against Obama because of the way in which the bill was passed. They have a point that there were so many concessions made in order to pass the bill that the final product was going to be an expensive unworkable disaster. Yet the reason for most of the concessions was to get support from enough senators and representatives to pass the bill.

Obama should argue that the current health care system is unaffordable, and the only way to reduce costs is via reform - however he can't do anything now, because everything he will try to do to reform health care will be blocked by the republicans in the Senate. I suspect that nothing much will happen for the next 2 years, Obama probably will lose the next election and health care will not change. Hopefully Sarah Palin will not become the next president of the USA. The end of the world - you heard it here first.

The British are coming!... (in April)

I have also been in contact with the next batch of rotators who are due to come here in April. Currently they are all going through the fun phase of filling hundreds of forms, writing letters, sending off some $$, having photos taken in US passport size, fingerprints taken, (DNA samples are not currently a requirement but they are working on it) - happy memories! Of course the real fun will start next month when they begin the visa application process... Last year seems like a really long time ago. A year ago it didn't really seem real that we were going to America for a year. It was very exciting and at the same time quite scary.

I can say very confidently to the new rotators who will be starting in April that they will have a great year. They will not regret their choice to come here. At times it will be very challenging, sometimes scary, and they will be out of the comfort zone a bit, but I have learnt so much from being here, and am still learning. I've learnt different ways of giving an anaesthetic (even different ways to spell it) - some of them I will use, and some I may just file under experience, but it definitely opens your mind up to different options. I've also learnt that you can anaesthetise most people just fine with a decent iv cannula and an endotracheal tube. It doesn't always pay to do anything too fancy.

It is also funny how we worry about different things on either side of the pond. A few examples: Etomidate, Suxamethonium, Nitrous Oxide and Isoflurane are not evil and dangerous, but target controlled infusions and suggamadex are so dangerous they are not approved by the FDA. Apparently it is OK to wear theatre scrubs in the supermarket or diner, but patients hair must be covered by a paper hat, and all personnel must wear surgical masks in the theatre at all times to prevent infections. It is also not necessary to scrub or wear a gown when placing a spinal or epidural - just sterile gloves over your watch will suffice, but an arterial line requires full aseptic precautions. Protecting the eyes with tape takes priority over checking you have an airway and patients will get definite corneal abrasions if they raise their hand above their belly button. Those who know what I am talking about will recognise my tongue in cheek tone and no offence or criticism is intended - It's just funny how our neuroses have a different emphasis.

I've met some really intelligent and interesting people and I've made great friends, who I'm sure I'll keep in touch with for the rest of my career. In short, coming here was a great decision!

So on Thursday I will have a lot to give thanks for, and top of the list will be thanks for this great opportunity, and for my new friends, and of course my wonderful family.

Happy Thanksgiving to all,

Drake.

Trick... or treat...???

Belated Happy Halloween everyone!



Halloween is a strange thing. It's not as most people see it now an American thing. It's celebrated in different shapes and sizes by many different cultures, and has been for centuries. The Scots called it All Hallows Eve, the Irish called it Samhain, the Welsh had Nos Calan Gaeaf, the Romans had Palantalia, the Spanish had the Day of the Dead. The underlying theme is very similar in all of them. It's basically a pagan celebration of the autumnal equinox - the passing of the light half of the world to the dark. It is the opposite of Easter - which of course is the festival of the Spring Equinox, a festival of the new light, and of new birth and fertility. The Celts thought of it as a time when the living and the dead came closer together and they would get a chance to see dead ancestors. The wearing masks and costumes was to scare off any bad spirits that may come with them. It was also a celebration of the end of the harvest and bonfires would be lit to burn off the carcasses and inedible waste after storing food for the winter.

The church of course tried to rebrand the festival like they did with Christmas and Easter, to All Saints Day - which is also a celebration of the dead.


Back at home I always felt it was more of an irritation. A night when extortion and minor vandalism was encouraged and of course for supermarkets to cash in on sweets, costumes, party gear, etc. I have to say I've never really thought much about it's Celtic roots and meanings before.

In America though it is huge. They really go mad for it here. It's a bigger thing than Christmas to some people. People decorate their whole house and garden - starting from the end of September, with ghosts and ghouls, skeletons, cemeteries in the garden, lights, spiders webs, fog machines and strobe lights. Speakers playing haunted music when you walk up their drive. Pumpkins and scarecrows are everywhere. It's also a big party time. There are lots of fancy dress parties for both children and adults, and the University students (in particular the girls) use it as an excuse to dress up and go out in Ann Summers gear.

We really got into the spirit this year on Halloween - (When in Rome...) - we had Pumpkins and scarecrows and decorations, and costumes, and we went Trick or treating with the kids, and spent a small fortune on Candy for the trick or treaters.

We had a great evening, but we were totally unprepared - despite being pre-warned by some of the previous rotators and our neighbours. The really nice thing was that it was a big family orientated community celebration. Our street was closed off, all the houses participated in some form. Some of the neighbours had parties. People gave out free hot apple cider. Some of the neighbours hosted a "haunted house" to explore. All the kids got dressed up and went round collecting candy in little orange pumpkin faced buckets. We met lots of neighbours we had never spoken to before and it was all very nice. Well - at the start of the evening at least. There were no "Tricks" at all. No egging of windows, or flour on cars, or general misdemeanours. It was just about giving out candy to the kids.

Now it just so happens that where we are living is a popular place for trick or treating amongst the local kids. So popular in fact that children from poor areas of Detroit get coached in by charities to our street for the evening to take part in trick or treating. This of course is very admirable but resulted in us being somewhat swamped and overwhelmed. So it wasn't a case of how many times did the doorbell go off.... We took it in turns sitting on our front porch while kids queued up to 30 deep by our door to get sweets and then move on to the next house!! Our neighbours counted 700 children had been through their front door in the space of a couple of hours. Our street was flooded with little ghosts, witches, superheroes and buzz lightyears. There was a papier mache procession at some point, but we didn't really get to see it because unfortunately we had bought not nearly enough sweets, so when the inevitable awkward moment came when we ran out and I had 30 kids at the door looking suddenly slightly more menacing, we bailed, turned out the lights and pretended to be out.

To anyone who has never experienced Halloween here - it really is strange. I definitely liked the street party atmosphere and the decorations, the family orientated activities, and the fact that the whole community participates - but I couldn't get my head round the candy-grabbing fest. The vast majority of kids were very polite and controlled and had a small bucket of sweets, but there were some who had bin liners that they were stuffing with as many sweets they could get their hands on and would grab from our supply without uttering a single word. It was an experience that I was very glad we took part in, and am very glad we won't be next year...

Oddly enough the passing of our world from the light to the dark and the beginning of winter occurred simultaneously with it getting pretty cold here. It is now minus 2 centigrade in the morning when I cycle to work, and the first snowfall is forecast for Friday. I am planning to cycle to work throughout the winter and have just invested in some good thermals. I think it is something that only the Brits do - sort of a badge of honour, but as we only have the one car I don't have much choice. I'm actually looking forward to it in a funny way.

Work goes on and I actually feel like a proper attending now. It's still hard work at times, but it comes more naturally, and my confidence has grown a lot after managing so many challenging cases. I look forward to difficult airways, and big liver resections, to super morbidly obese patients (as long as they are not too often). I lectured on an Airway course last week, and I've helped out with some human factors training in the Simulation Centre. The Sim centre here is incredible, and I can't believe I have only just found it. It is very well equipped, and has amazing resources. The only problem is a very familiar one - no-one is given time off clinical duties to go there and learn, so I think it is relatively underused for it's potential, but that is something they are trying to change. Simulation training is going to have a big place in the future of medical training and assessment, and at present I actually think that things are a little behind here than in the UK. The equipment and resources here are very impressive - but it is not being used. One of the problems of having a much shorter residency programme is that there are fewer residents around to do the clinical work, and less time available therefore for non-clinical activities. There are people who are very enthusiastic about it and are trying to change this however.

Till next time - Happy Divali - the light after the dark?

Drake.