Dreams come true...

It's done then.

Our year in the US of A has come to an end. For the new bunch of rotators the adventure is just beginning, and we were just a tad jealous meeting them last week.

Last week I finished work, said some very sad goodbyes, cleared out my office desk, packed up and left. The last few months seem to have gone by quicker than any others. Possibly because I've been pretty busy. As always there is never any let up or easing off at work. I was busy right up to the end, as was my very patient wife. On top of our usual day jobs we also had to plan our trip home (including a nice holiday in Florida en route), organise shipping of some of our stuff, pack up the rest, fill out paperwork for leaving, fill out paperwork for starting my new job in the UK, try and find somewhere to live in the UK - (still working on that one), pack our bags, clean up and go. It's been a pretty stressful month. It seems moving home has been more stressful than the move out here. All is good now though. Nothing a bit of sun, sea and sugar coated Disney can't fix.

So the final tally for our year in the States (non-medical readers feel free to skip this bit):

I was the recorded attending anesthesiologist for 1100 cases. About 350 cases were Head and Neck - my chosen speciality here. I learned how to manage an array of difficult airway problems using techniques I'd never used before, as well as brushing up on a few skills I already had. I managed some interesting surgical cases that I'd never seen before - radical head and neck dissections with free flaps; robotic surgery for anything from prostatectomy, cystectomy, even a tonsil tumour - ectomy; bariatric surgery, liver resections, craniotomies for deep brain stimulator insertions to name a few. I've learned to modify my techniques to allow different neurophysiological monitoring like MEPs & SSEPs. I've learnt that you can give an anaesthetic that consists of Propofol, Remifentanil, Isoflurane, Nitrous Oxide and Ketamine all at the same time. I've learned to use new drugs such as Sufentanil, Dexmedetomidine, and used other drugs such as Ketamine a lot more than I had ever used before. I've managed much sicker patients than ever before, with the majority of patients ASA 3 and 4 with multiple medical problems, and a huge list of medicines (and allergies) Everyone in the States seems to be allergic to Sulfa. To this day I'm still not sure what drugs that's relevant for but there you go. I've learned that you can anaesthetise pretty much anyone as long as you're careful. I've also had good experience with managing the larger patient. My highest recorded BMI was 67. I got off lightly though - one of my colleagues had a patient with a BMI of 78.

I've learned to supervise two rooms at once (although I don't think I ever mastered this). It's good though to see different ways of working. I have had plenty of opportunity to teach the residents - some of whom are very intelligent, keen and a joy to work with, others who seem disinterested or think they know it all already. I have found that often residents use confidence to hide gaping holes in their knowledge, and it doesn't take long to work out who knows what they are doing and who needs closer watching. The majority though have been excellent. Intelligent, hard working and good fun to work with. I also interviewed candidates for the residency programme which was a new and interesting experience.

As well as teaching up to two residents a day I've had plenty of other teaching opportunities. I've lectured the medical students (I had a standard lecture on cardiovascular physiology) who are much brighter and much keener than I ever was as a student. I've helped with starting a Simulation course to teach Human Factors to the residents, including programming a scenario in to the Meti Simulator. I gave a lecture and taught on an Airway course arranged by the department. I also supervised some of the residents core teaching sessions and journal clubs.

I've also had some great research experience, including transforming an idea in to a formal research proposal, then collecting and analysing data, and writing up our findings, though it's still some way from being submitted. Hopefully I'll get the opportunity to present it at this years ASA conference in Chicago.

So all in all, I think I have surpassed my objectives for coming here. It is unlikely I could have done all of the above had I stayed in the UK for the last year. I probably could have done most of the above in the UK, but it would probably have taken a couple of years. It's felt like I've had 2 years of training crammed into a year. The reasons are complicated, but the European Working Time Directive and the New Deal have affected working patterns, reducing our clinical experience. There is also a big service commitment to our job, which means lots of night shifts, lots of time covering intensive care or labour wards. I am not saying that this is bad. In fact one other thing I have learnt in the last year is that our training is actually excellent. I was able to come and work in a big academic department in another country at an attending level (the equivalent here of a junior consultant). If I had stayed at home I'm sure I would have had excellent training. But it would have just been more of the same. By going abroad, and in particular the USA I have experienced a whole load of different things. Of course one of my main reasons to come to the USA was for none of the above, but to travel and see more of this great nation.

The places we wanted to visit but didn't include New York City, California, Yellowstone National Park, Hawaii, Oregon and Alaska. We have no regrets about this though, because I'm sure we'll be back. America is too big to visit in a year. Most Americans don't see it all in a lifetime. We've done pretty well though.

We saw a lot of Michigan obviously, and I really think it has a lot to offer. It's a beautiful state with lovely parks and beaches. Detroit is a fascinating city - Sadly much of it derelict, but I'm sure it will be back on it's feet soon. The Henry Ford museum is a must if you ever go there. The beaches on lake Michigan, Sleeping Bear Dunes, Glen Arbor, Petoskey, Mackinac, Taiquonamen Falls, Kensington and Pinckney Parks were our favourite places in Michigan. And Ann Arbor itself of course. Ann Arbor is a great place to live - A city with a town feel, and so much to do there. We also went to the following states:

Ohio, New York, Pennsylvania, West Virginia, Virginia, Washington DC, North Carolina, Tennessee, Kentucky, Indiana, Illinois, Colorado and now Florida. Only 36 states we didn't go to!

It is fitting in a way that we have chosen to end our year at Disneyworld Florida. It is in some ways a small concentrated extreme version of America. Somewhere that you can love or hate, or sometimes both at the same time. A cynical person will tell you all the things to hate about it - it's brash, fake, over commercialised; everything is designed to extract as much money from you as possible; everything is sugar coated (not just the food); it brings out the worst in people - greed and selfishness; it's busy and crowded unless you can afford the VIP treatment. I can't really disagree with any of these arguments. But it's also such a positive place. Efficient and professional yet warm and friendly. Vast and crowded yet with great little places to get away from it all. It brings out the best in people - a sense of community and shared happiness. It is magical and inspirational. A place where "Dream's come true" - (as long as you can afford them). Love it or hate it - it is what it is. I for one hope it never changes. There are things I'd like to change about America, but if I did it wouldn't be America.

I think the American within me has come out a bit more in the last year. I haven't become American, I've always been one at heart. A friend of mine once said that we are all Americans now, we just can't vote there! He has a point. What ever happens in America affects the whole world - just look at the affect of some Americans defaulting on their home mortgages! We look to America to bring the rest of the world out of bad economic times. We rely on America for military security - whether we like it or not. We seem to need reassurance from America more and more. We've grown up watching American TV shows and films and our culture has become more and more American. Whether you like it or not, Britain today is more like America than Britain of two generations ago. If I could bring one more bit of America home with me it would be the optimism and "Can do" attitude to everything. Rather than whinge about a problem, wouldn't it be great if people just went out there to fix it.

What I've come to realise is that politically I am actually more American than I thought too. I don't mean we should legalise guns and abandon the NHS. What I mean is there should be rewards for working hard. People should never be in a position where they are better off not working, thereby staying on state benefits for years and years. Work is good for people and good for society, and to encourage people to work you have to make it worth their while. It shouldn't matter where you are from or what class you are, or what your family did. All that should matter is what you can do. Of course there should be a safety net for those who can't work or who have been unfortunate, but it should be just that - a safety net to help people get back on the show. People should be more responsible for themselves - if you don't like the situation you are in, get out there and fix it. If this sounds obvious to you then maybe you're American too.

My advice to anyone coming here - whether it is to work or to play - is leave any preconceptions and prejudices at immigration (they have plenty here already) and just explore and experience as much as possible. Take it all in, and embrace the American life. I'm sure you won't like everything here, but I'm also sure there is something for everyone here.



So... Will we be back?



Of course! - but most likely just for holidays. To come back to work would mean having to sit the USMLE exams, and jobs and visa are hard to come by. It's not beyond the realms of possibility though, and in true American fashion, If we really wanted to we could probably do it - with hard work.

We'll be spending our last night watching the fireworks at the Magic Kingdom with a few cocktails. We arrive back in the UK on Wednesday 6th April (new tax year). I have 12 days before starting back at work. Looking forward to seeing y'all again real soon and keep checking in - I intend to do at least one more blog after we return.


Hope all your dreams come true!

Drake.